{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T19:27:00Z","timestamp":1762543620695,"version":"3.41.2"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T00:00:00Z","timestamp":1646956800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The management of malperfusion is vital to improve the outcomes of surgery for acute type A acute aortic dissection (ATAAD). Open arch repair under hypothermic circulatory arrest with selective antegrade cerebral perfusion (HCA\/sACP) is safe and efficient but associated with inevitable hypothermia and ischemia-reperfusion injury. The aortic balloon occlusion (ABO) technique is shown to be organ protective by allowing higher temperature and shorter circulatory arrest time. In this study, we aimed to evaluate the safety and efficacy of this new technique for ATAAD patients with lower body malperfusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between January 2013 and November 2020, 355 ATAAD patients with lower body malperfusion who underwent arch repair in our institute were enrolled. The patients were divided into 2 groups: ABO group (<jats:italic>n<\/jats:italic> = 85) and HCA\/sACP group (<jats:italic>n<\/jats:italic> = 271). Propensity score matching was performed to correct baseline differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Using the propensity score matching, 85 pairs were generated. Circulatory arrest time was significantly lower in the ABO group compared with the HCA\/sACP group (median, 8 vs. 22 min; <jats:italic>p<\/jats:italic> &amp;lt; 0.001). The incidence of in-hospital mortality (10.6 vs. 12.9%; <jats:italic>p<\/jats:italic> = 0.812), stroke (7.1 vs. 7.1%; <jats:italic>p<\/jats:italic> = 1.000), dialysis (25.9 vs. 32.9%; <jats:italic>p<\/jats:italic> = 0.183), hepatic dysfunction (52.9 vs. 57.6%; <jats:italic>p<\/jats:italic> = 0.537), tracheostomy (4.7 vs. 2.4%; <jats:italic>p<\/jats:italic> = 0.682), paraplegia (1.2 vs. 4.7%; <jats:italic>p<\/jats:italic> = 0.368) were comparable between ABO and HCA\/sACP groups. Other outcomes and major adverse events were comparable. The multivariable logistic analysis did not recognize ABO technique protective against any major adverse outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>For ATAAD patients with lower body malperfusion, the ABO technique allows the performance of arch repair with frozen elephant trunk (FET) under higher temperature and shorter circulatory arrest time. However, ABO technique did not improve perioperative outcomes. Future studies are warranted to evaluate the efficacy of this technique.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.835896","type":"journal-article","created":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T06:37:44Z","timestamp":1646980664000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Aortic Balloon Occlusion Technique Does Not Improve Peri-Operative Outcomes for Acute Type A Acute Aortic Dissection Patients With Lower Body Malperfusion"],"prefix":"10.3389","volume":"9","author":[{"given":"Guang","family":"Tong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhongchan","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinlin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuang","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zerui","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donglin","family":"Zhuang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaorong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongchao","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhichao","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruixin","family":"Fan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tucheng","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"65","DOI":"10.21037\/jovs.2018.03.13","article-title":"Malperfusion syndromes in type A aortic dissection: what we have learned from IRAD","volume":"4","author":"Berretta","year":"2018","journal-title":"J Vis Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1757","DOI":"10.1111\/jocs.15025","article-title":"Management of malperfusion: New York approach and outcomes","volume":"36","author":"Iannacone","year":"2021","journal-title":"J Card Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"2628","DOI":"10.1016\/j.jacc.2015.04.030","article-title":"The Impact of pre-operative malperfusion on outcome in acute type A aortic dissection: results from the GERAADA registry","volume":"65","author":"Czerny","year":"2015","journal-title":"J Am Coll Cardiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/j.jtcvs.2021.04.053","article-title":"2021 The American Association for Thoracic Surgery expert consensus document: surgical treatment of acute type A aortic dissection","volume":"162","author":"Malaisrie","year":"2021","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1093\/ejcts\/ezu284","article-title":"Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe","volume":"47","author":"De Paulis","year":"2015","journal-title":"Eur J Cardiothorac Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.1016\/j.athoracsur.2020.04.144","article-title":"Type-A aortic dissection and cerebral perfusion: the society of thoracic surgeons database analysis","volume":"110","author":"O'hara","year":"2020","journal-title":"Ann Thorac Surg."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2019.08.074.","article-title":"Aortic balloon occlusion technique versus moderate hypothermic circulatory arrest with antegrade cerebral perfusion in total arch replacement and frozen elephant trunk for acute type A aortic dissection","author":"Liu","year":"2019","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1161\/CIRCULATIONAHA.110.015081","article-title":"Total arch replacement combined with stented elephant trunk implantation: a new \u201cstandard\u201d therapy for type a dissection involving repair of the aortic arch?","volume":"123","author":"Sun","year":"2011","journal-title":"Circulation."},{"key":"B9","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1016\/j.jtcvs.2015.03.023","article-title":"The impact of surgical strategy on survival after repair of type A aortic dissection","volume":"150","author":"Lawton","year":"2015","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1750","DOI":"10.1016\/j.jtcvs.2018.09.020","article-title":"Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection","volume":"157","author":"Geirsson","year":"2019","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e44","DOI":"10.1093\/ejcts\/ezv356","article-title":"Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA)","volume":"49","author":"Conzelmann","year":"2016","journal-title":"Eur J Cardiothorac Surg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.1093\/ejcts\/ezv310","article-title":"A new device as an open stent graft for extended aortic repair: a multicentre early experience in Japan","volume":"49","author":"Uchida","year":"2016","journal-title":"Eur J Cardiothorac Surg."},{"key":"B13","doi-asserted-by":"crossref","DOI":"10.1016\/j.jtcvs.2021.03.079","article-title":"Comparative study of Japanese frozen elephant trunk device for open aortic arch repairs","volume-title":"J Thorac Cardiovasc Surg.","author":"Ogino","year":"2021"},{"key":"B14","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.jtcvs.2019.01.127","article-title":"Aortic arch surgery with hypothermic circulatory arrest and unilateral antegrade cerebral perfusion: perioperative outcomes","volume":"159","author":"Wang","year":"2020","journal-title":"J Thorac Cardiovasc Surg."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.835896\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T06:37:47Z","timestamp":1646980667000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.835896\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,11]]},"references-count":14,"alternative-id":["10.3389\/fcvm.2022.835896"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2022.835896","relation":{},"ISSN":["2297-055X"],"issn-type":[{"type":"electronic","value":"2297-055X"}],"subject":[],"published":{"date-parts":[[2022,3,11]]},"article-number":"835896"}}