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Technical advances in total aortic arch replacement.

Justus T Strauch1, David Spielvogel, Alexander Lauten

  • 1Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York University, New York, New York, USA. ju.strauch@gmx.de

The Annals of Thoracic Surgery
|February 5, 2004
PubMed
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Hypothermic circulatory arrest with selective cerebral perfusion and a trifurcated graft (HCA/SCP/T) significantly reduces adverse outcomes and complications during aortic arch repair compared to earlier methods. This optimal technique may improve patient recovery and shorten hospital stays.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Aortic arch repair is a complex procedure with significant risks.
  • Different techniques for managing cerebral protection during aortic arch repair have evolved.

Purpose of the Study:

  • To compare the outcomes of three aortic arch repair techniques: hypothermic circulatory arrest (HCA) alone, HCA with selective cerebral perfusion (SCP), and HCA/SCP with a trifurcated graft (T).
  • To evaluate the effectiveness of these techniques in preventing adverse outcomes, such as death or stroke, and reducing complications.

Main Methods:

  • A retrospective analysis of 150 patients undergoing total aortic arch replacement between 1988 and 2002.
  • Patients were divided into three groups based on the technique used: HCA, HCA/SCP, and HCA/SCP/T.

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  • Groups were matched for age, urgency, and preoperative risk factors.

    • Main Results:

    • The HCA/SCP/T group showed a trend toward lower adverse outcomes (8%) compared to HCA (16%) and HCA/SCP (16%).
    • Transient neurologic dysfunction was significantly lower with HCA/SCP/T (11%) versus HCA (33%) or HCA/SCP (17%).
    • HCA/SCP/T demonstrated significant reductions in respiratory, infectious, and cardiac complications, with shorter intensive care and hospital stays.

    Conclusions:

    • HCA/SCP is superior to HCA alone in preventing cerebral injury during aortic arch repair.
    • HCA/SCP/T, utilizing axillary artery cannulation, appears to be the optimal technique for minimizing embolic risk, reducing HCA duration, averting adverse outcomes, and shortening hospitalization.