Perfusion management of aortic balloon occlusion technique in total arch replacement with frozen elephant trunk

To ensure both cerebral and lower body perfusion during total arch replacement with frozen elephant trunk, aortic balloon occlusion technique has been applied in some cases at our institute. During the procedure, after stented elephant trunk is inserted into the true lumen of the descending aorta, an aortic balloon catheter is placed and inflated within the stented elephant trunk, occluding the orifice of descending aorta. Then, lower body perfusion is provided via femoral cannulae during distal aortic arch anastomosis. We describe the perfusion management strategy of the technique, elucidate intraoperative monitoring parameters, and clarify the feasibility of the method from the aspect of perfusion.