{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T14:19:00Z","timestamp":1762957140606,"version":"build-2065373602"},"reference-count":8,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T00:00:00Z","timestamp":1684886400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Aortic arch pathologies represent a surgical challenge. The challenge is partly due to the necessity of complex cerebral, visceral, and myocardial protection measures. Aortic arch surgery generally requires a significant duration of circulatory arrest, which includes deep hypothermia levels with the associated sequelae. This retrospective observational study shows the feasibility of a strategy that reduces circulatory arrest duration and eliminates the need for deep hypothermia during the procedure. Materials and Methods: Between January 2022 and January 2023, 15 patients (n = 15) with type A aortic dissection underwent total arch replacement with a frozen elephant trunk. Cardiopulmonary bypass and organ perfusion were established via arterial lines in the right axillary artery and one of the femoral arteries. In the latter vessels, a y-branched arterial cannula was used (ThruPortTM), allowing for endo-clamping of the stent part of the frozen elephant trunk with a balloon and subsequent perfusion of the lower body. Results: Applying this modified perfusion technique, circulatory arrest time could be reduced to a mean of 8.1 \u00b1 4.2 min, and surgery was performed at a mean lowest body temperature of 28.9 \u00b1 2.3 \u00b0C. The mean ICU and hospital stays were 18.3 \u00b1 13.7 days and 23.8 \u00b1 11.7 days, respectively. The rate for 30-day survival was 100%. Conclusions: By applying our modified perfusion technique, the circulatory arrest duration was below ten minutes. As a consequence, deep hypothermia could be avoided, and surgery could be performed at moderate hypothermia. Future studies will have to show whether these changes may be translated into a clinical benefit for our patients.<\/jats:p>","DOI":"10.3390\/medicina59061007","type":"journal-article","created":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T01:29:26Z","timestamp":1684891766000},"page":"1007","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Strategy for Minimizing Circulatory Arrest Duration in Complex Aortic Arch Procedures"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7340-7472","authenticated-orcid":false,"given":"Robert","family":"Balan","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Klinikum Passau, 94032 Passau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petar","family":"Soso","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Klinikum Passau, 94032 Passau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Parwis","family":"Massoudy","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Klinikum Passau, 94032 Passau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Till","family":"Proschek","sequence":"additional","affiliation":[{"name":"Department of Vacular Surgery, Klinikum Passau, 94032 Passau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wiebke","family":"Kurre","sequence":"additional","affiliation":[{"name":"Department of Radiology, Klinikum Passau, 94032 Passau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Mogilansky","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Klinikum Passau, 94032 Passau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1055\/s-0030-1271042","article-title":"Aortic arch repair: Let it beat!","volume":"60","author":"Klopsch","year":"2012","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_2","first-page":"91","article-title":"Early outcome of aortic balloon occlusion during total aortic arch replacement with the frozen elephant trunk technique for aortic dissection","volume":"30","author":"Li","year":"2020","journal-title":"Interact Cardiovasc. Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1093\/ejcts\/ezy357","article-title":"Incorrect frozen elephant trunk deployment into the false lumen of a patient with complicated type B acute dissection","volume":"55","author":"Fujii","year":"2019","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1007\/s11748-020-01399-y","article-title":"Hypothermic circulatory arrest induced coagulopathy: Rotational thromboelastometry analysis","volume":"68","author":"Ise","year":"2020","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"25","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","volume":"161","author":"Liu","year":"2021","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1055\/s-0038-1639478","article-title":"Moderate Hypothermic Circulatory Arrest (\u226528 \u00b0C) with Selective Antegrade Cerebral Perfusion for Total Arch Replacement with Frozen Elephant Trunk Technique","volume":"67","author":"Ahmad","year":"2019","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"262","DOI":"10.21037\/cdt-22-73","article-title":"Normothermic frozen elephant trunk: Our experience and literature review","volume":"12","author":"Malvindi","year":"2022","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1055\/s-0041-1741058","article-title":"Left Subclavian Artery Sacrifice in Acute Aortic Dissection Repair using the Frozen Elephant Trunk","volume":"70","author":"Goebel","year":"2022","journal-title":"Thorac. Cardiovasc. Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/6\/1007\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:40:42Z","timestamp":1760125242000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/6\/1007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,24]]},"references-count":8,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["medicina59061007"],"URL":"https:\/\/doi.org\/10.3390\/medicina59061007","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2023,5,24]]}}}