Brachiocephalic trunk partial clamping for total ascending aorta replacement without circulatory arrest

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Ascending aorta replacement often requires circulatory arrest, increasing stroke risk.
• Aortic arch calcification complicates standard clamping techniques.
• Alternative methods are needed to reduce morbidity in aortic surgery.

Purpose of the Study:

• To evaluate a novel technique for total ascending aorta replacement without circulatory arrest.
• To assess the safety and efficacy of oblique aortic arch clamping in select patients.

Main Methods:

• A modified clamping strategy was employed, positioning an oblique clamp from the brachiocephalic trunk to the distal aortic arch.
• This technique was applied to 8 consecutive patients undergoing elective total ascending aorta replacement.
• Patients selected had no evidence of aortic arch calcification.

Main Results:

• The described oblique clamping technique was successfully implemented in all 8 patients.
• No patient experienced any surgical complications during the study period.
• This approach facilitated ascending aorta replacement without the need for circulatory arrest.

Conclusions:

• Oblique aortic arch clamping is a safe and effective alternative to circulatory arrest for ascending aorta replacement in patients without aortic arch calcification.
• This technique simplifies the procedure and potentially reduces neurological complications.
• Further studies are warranted to validate these findings in larger cohorts.