Prosthetic replacement of the aortic arch.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Aortic arch aneurysms pose significant life-threatening risks.
• Surgical repair of the aortic arch presents complex challenges due to its critical location and vascular supply.

Purpose of the Study:

• To evaluate the safety and efficacy of aortic arch replacement using total body hypothermia and circulatory arrest.
• To assess the outcomes in patients undergoing aortic arch prosthesis implantation.

Main Methods:

• Four patients with aortic arch aneurysms (dissecting or arteriosclerotic) underwent aortic arch replacement.
• A combination of surface cooling and cardiopulmonary bypass induced total body hypothermia.
• Arch replacement was performed during total circulatory arrest, followed by rewarming and cardiac resuscitation.

Main Results:

• The average duration of cerebral ischemia was 43 minutes and myocardial ischemia was 74 minutes.
• The average lowest esophageal and rectal temperatures reached were 14°C and 18°C, respectively.
• Three out of four patients survived and were well at 4-13 months post-surgery; one patient died from pulmonary insufficiency.

Conclusions:

• Total body hypothermia and circulatory arrest enable aortic arch replacement with an acceptable mortality rate.
• This surgical approach can be offered to patients with life-threatening aortic arch aneurysms.