Aortic Balloon Occlusion in Repair of Ruptured Abdominal Aortic Aneurysm

This case report details a novel technique implemented in Vietnam. When full equipment is unavailable, we adapt it by using aortic balloon occlusion to enhance the patient's hemodynamics and mitigate the risk of intraprocedural exsanguination. This approach effectively addresses the rupture of abdominal aortic aneurysms in patients with unstable hemodynamic conditions.

Corrigendum: The combination of chest compression synchronized ventilation and aortic balloon occlusion improve the outcomes of cardiopulmonary resuscitation in swine

[This corrects the article DOI: 10.3389/fmed.2022.1057000.].

The combination of chest compression synchronized ventilation and aortic balloon occlusion improve the outcomes of cardiopulmonary resuscitation in swine

Aim

The primary mission of cardiopulmonary resuscitation (CPR) is to provide adequate blood flow and oxygen delivery for restoring spontaneous circulation from cardiac arrest (CA) events. Previously, studies demonstrated that chest compression synchronized ventilation (CCSV) improved systemic oxygen supply during CPR, and aortic balloon occlusion (ABO) augments the efficacy of external CPR by increasing blood perfusion to vital organs. However, both them failed to make a significant improvement in return of spontaneous circulation (ROSC). In this study, we investigated the effects of combined CCSV and ABO on the outcomes of CPR in swine.

Methods

Thirty-one male domestic swine were subjected to 8 min of electrically induced and untreated CA followed by 8 min of CPR. CPR was performed by continuous chest compressions and mechanical ventilation. At the beginning of CPR, the animals were randomized to receive intermittent positive pressure ventilation (IPPV, n = 10), CCSV (n = 7), IPPV + ABO (n = 7), or CCSV + ABO (n = 7). During CPR, gas exchange and systemic hemodynamics were measured, and ROSC was recorded. After resuscitation, the function and injury biomarkers of vital organs including heart, brain, kidney, and intestine were evaluated.

Results

During CPR, PaO₂ was significantly higher accompanied by significantly greater regional cerebral oxygen saturation in the CCSV and CCSV + ABO groups than the IPPV group. Coronary perfusion pressure, end-tidal carbon dioxide, and carotid blood flow were significantly increased in the IPPV + ABO and CCSV + ABO groups compared with the IPPV group. ROSC was achieved in five of ten (IPPV), five of seven (CCSV), six of seven (IPPV + ABO), and seven of seven (CCSV + ABO) swine, with the rate of resuscitation success being significantly higher in the CCSV + ABO group than the IPPV group (P = 0.044). After resuscitation, significantly improved myocardial and neurological function, and markedly less cardiac, cerebral, renal, and intestinal injuries were observed in the CCSV + ABO group compared with the IPPV group.

Conclusion

The combination of CCSV and ABO improved both ventilatory and hemodynamic efficacy during CPR, promoted ROSC, and alleviated post-resuscitation multiple organ injury in swine.

Spiral Suture of the Lower Uterine Segment with Temporary Aortic Balloon Occlusion in Morbidly Adherent Placenta Previa Cases

Purpose

We aimed to investigate the combined effect of spiral suture of the lower uterine segment with intraoperative aortic balloon occlusion in morbidly adherent placenta previa cases.

Patient and Methods

This retrospective, single-center study involved patients from 2017 to 2020. The study considered 68 cases of morbidly adherent placenta previa cases from medical records retrospectively with age ranging from 23 to 42 years. Bilateral uterine artery embolization was performed, to control excessive bleeding. Perioperative blood loss, hysterectomy rate, amount of blood transfusion, balloon occlusion time, fetal and maternal radiation dose, and postpartum complications were assessed.

Results

A total of 68 patients underwent surgery. Hysterectomy was performed in three patients and uterine artery embolization in 21 patients. Of 53 patients who required blood transfusions, the amount of packed red blood cells given was 800 mL and the amount of plasma given was 400 mL. Median abdominal aortic balloon occlusion time was 17 minutes. Fetal and maternal radiation doses were 5 mGy and 12 mGy, respectively. One patient experienced surgery-related complications, a bladder injury. No major catheterization-related and postpartum complications were observed.

Conclusion

Fertility-sparing surgery for women with morbidly adherent placenta could include abdominal aortic balloon occlusion and spiral suture of lower uterine segment.

Aortic balloon occlusion simplifies dissected thoracoabdominal aortic aneurysm repair after frozen elephant trunk

Here, we report a case of a dissected thoracoabdominal aortic aneurysm repair after frozen elephant trunk implantation, using aortic balloon occlusion technique to simplify the proximal anastomosis and avoid deep hypothermic circulatory arrest.

Application of the aortic balloon occlusion technique in Sun's procedure: A single-center study

OBJECTIVES

To study the impact of a balloon occlusion (BO) technique in stented elephant trunk implantation in Sun's procedure for acute Stanford type A aortic dissection (AAAD) on important postoperative organ complications and patient rehabilitation.

METHODS

Eighty-five patients with AAAD who underwent Sun's procedure from January 2019 to January 2020 were selected. Cases were divided into two groups based on whether the aortic BO technique was used in stented elephant trunk implantation: the BO group and the nonballoon occlusion (NBO) group. The collected data included the patients' clinical characteristics, operative data, postoperative complications and recovery. We applied statistical software to study the impact of a BO technique in stented elephant trunk implantation in Sun's procedure.

RESULTS

A total of 85 patients with AAAD underwent Sun's procedure. A total of 29 used BO technique, 56 did not use. The circulatory arrest time in the BO group was controlled within 8.07 ± 2.33 min, and the nasopharyngeal temperature dropped to 28°C. Overall postoperative complications were less frequent in BO group than NBO group (52% vs. 75%; p = .030). Using BO technique, we reduced the 24-h drainage volume, and lowered the occurrence of hypoxemia (48%), liver dysfunction (10%), and median tracheal intubation time was 37 h (range: 12.5-106 h), median intensive care unit (ICU) time was 65 h (range: 17-207 h).

CONCLUSIONS

During total aortic arch replacement and stented elephant trunk surgery for AAAD, we used the aortic BO technique, which avoids deeper hypothermia and effectively shortens circulatory arrest times. This approach is helpful for reducing the incidence of postoperative complications and shortening the intensive care unit time. This method also reduces the patient's medical burden and facilitates faster recovery.

Application of Aortic Balloon Occlusion in Total Aortic Arch Replacement with Frozen Elephant Trunk on Clinical Endpoints for Aortic Dissection Patients

Purpose: Total aortic arch replacement (TAR) with frozen elephant trunk (FET) is the standard operation for treating aortic dissection (AD) patients involving aortic arch with high operative risk due to long circulatory arrest (CA). We used aortic balloon occlusion technique that safely reduced the CA time to 5 min in average and investigated whether it can improve the clinical endpoints.

Methods: All patients diagnosed with AD and underwent TAR with FET operation (123 with aortic balloon occlusion and 221 with conventional method) in Fuwai Hospital during August 2017 and February 2019 was reviewed in this retrospective observational study.

Results: After propensity score matching, the 30-day mortality of aortic balloon occlusion group and conventional group was 4.88% and 11.38% (P = 0.062), respectively. In multivariate analysis, aortic balloon occlusion is one of the factors that reduced the risk for renal and hepatic injury, shortened postoperative conscious revival time, and reduced red blood cell (RBC) transfusion during operation.

Conclusions: The aortic balloon occlusion technique, as a perfusion strategy during operation, could alleviate postoperative complication. This method deserves further attention in future clinical practice for its value in treating patients with higher operative risks.

The strategy of cardiopulmonary bypass for total aortic arch replacement and the frozen elephant trunk technique with aortic balloon occlusion

Objective

To investigate the use of the aortic balloon occlusion technique to assist total aortic arch replacement (TAR) with frozen elephant trunk (FET) to shorten the lower body circulatory arrest (CA) time and raise the nadir temperature during cardiopulmonary bypass.

Methods

This retrospective study reviewed consecutive patients that underwent aortic balloon occlusion to assist TAR with FET and patients that received conventional TAR with FET procedures. Preoperative characteristics, perioperative characteristics and postoperative outcomes were compared between the two groups.

Results

The study included130 patients treated with aortic balloon occlusion and 230 patients treated with conventional TAR with FET. The 30-day mortality rate was similar between the aortic balloon occlusion and conventional groups (4.62% versus 7.83%, respectively). Multivariate analysis showed that aortic balloon occlusion reduced the incidence of acute kidney injury, hepatic injury and red blood cell transfusion. The application of aortic balloon occlusion reduced the mean ± SD CA time from 17.24 ± 4.36 min to 6.33 ± 5.74 min, with the target nadir nasal temperature being increased from 25°C to 28°C.

Conclusion

The aortic balloon occlusion technique achieved significant improvements in reducing complications, but this did not translate into lower 30-day mortality.

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

BACKGROUND

Moderate hypothermic circulatory arrest (MHCA) with antegrade cerebral perfusion (ACP) is safe and efficient in total arch replacement (TAR) and frozen elephant trunk (FET) for acute type A aortic dissection (ATAAD). Complications related to hypothermia and ischemia are inevitable, however. The aortic balloon occlusion (ABO) technique is performed to elevate the lowest nasopharyngeal temperature to 28°C and shorten the circulatory arrest time. In this study, we aimed to evaluate the efficacy of this new technique.

METHODS

We reviewed the clinical data of patients with ATAAD who underwent TAR and FET, including 79 who underwent ABO and 109 who underwent MHCA/ACP.

RESULTS

Circulatory arrest time was significantly lower in the ABO group compared with the MHCA/ACP group (mean, 4.8 ± 1.2 minutes vs 18.4 ± 3.1 minutes; P < .001). The composite endpoint was comparable in the 2 groups (11.4% for ABO vs 13.8% for MHCA/ACP; P = .631). Fewer patients in the ABO group developed high-grade acute kidney injury (AKI) according to a modified RIFLE criterion (22.8% vs 36.7%; P = .041), and the rate of hepatic dysfunction was lower in the ABO group (11.4% vs 28.4%; P = .005). Multivariable logistic analysis showed that the ABO technique is protective against duration of ventilation >24 hours (odds ratio [OR], 0.455; 95% confidence interval [CI], 0.234-0.887; P = .021), hepatic dysfunction (OR, 0.218; 95% CI, 0.084-0.561; P = .002), and grade II-III AKI (OR, 0.432; 95% CI, 0.204-0.915; P = .028).

CONCLUSIONS

The ABO technique significantly shortens the circulatory arrest time in TAR and FET. Available clinical data suggest that it has a certain protective effect on the liver and kidney. Future large-sample studies are warranted to thoroughly evaluate this new technique.

Aortic balloon occlusion for controlling intraoperative hemorrhage in patients with placenta previa increta/percreta

BACKGROUND/AIMS

To investigate whether abdominal aortic balloon occlusion (ABO) effectively reduces intraoperative hemorrhage in patents with placenta previa increta/increta.

METHODS

Forty-three women were diagnosed as placenta previa increta/percreta by ultrasound and MRI. These patients' assessments were taken by their chief physician, and they were under necessity of previous cesarean section as confirmed by the committee of experts during consultation. There was no significant difference in disease risk rating between them in whole process. Although our department provided a more appropriate method, 10 of 43 patients chose intraoperative aortic balloon occlusion (IABO). Other 33 patients who refused that suggestion were considered as control group. Fully informed consents were obtained from all patients in this study group. The intraoperative blood loss, blood transfusion, rate of hysterectomy and complications of mothers and fetus of IABO group and control group were analyzed.

RESULTS

The median intraoperative blood loss was 1000 ml in the IABO group compared with 2000 ml in the control group (p < 0.05). The median volume of transfused red blood cells was 1100 ml in the IABO group compared with 2000 ml in the control group (p < 0.05). 33.3% (11/33) patients in the control group had hemorrhagic shock, and one of them suffered from cardiac arrest intraoperatively because of severe bleeding. However, none of these serious events occurred in the IABO group (p < 0.05). The hysterectomy rate was 70% (7/10) in the IABO group and 63.3% (21/33) in the control group (p > 0.05). No IABO-related complications were observed in the mother and fetus.

CONCLUSION

IABO is an effective and safe method to control intraoperative blood loss and blood transfusion in patients with placenta previa increta/percreta.