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Aortic arch replacement using a trifurcated graft: simple, versatile, and safe.

David Spielvogel1, James C Halstead, Matthias Meier

  • 1Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA.

The Annals of Thoracic Surgery
|June 25, 2005
PubMed
Summary
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A trifurcated graft technique for aortic arch replacement using hypothermic selective antegrade cerebral perfusion resulted in low rates of mortality and stroke. This method offers a safe and effective approach to complex aortic arch surgeries.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Hypothermic selective antegrade cerebral perfusion is crucial for preventing neurologic complications during aortic arch replacement.
  • Traditional methods for cerebral perfusion include balloon-tipped catheters or branched grafts.
  • A trifurcated graft offers an alternative technique for aortic arch reconstruction.

Purpose of the Study:

  • To evaluate the safety and efficacy of a trifurcated graft for total aortic arch replacement.
  • To assess the incidence of adverse neurologic sequelae and perioperative outcomes using this technique.

Main Methods:

  • A consecutive series of 109 patients underwent nonemergent total aortic arch replacement using a trifurcated graft between September 1999 and October 2004.

Related Experiment Videos

  • The trifurcated graft was utilized for selective cerebral perfusion during hypothermic circulatory arrest for arch reconstruction.

    • Main Results:

    • The study reported an 8.3% adverse outcome rate, including 4.6% hospital death and 4.6% stroke.
    • Transient neurologic dysfunction occurred in 5.5% of patients.
    • Mean hypothermic circulatory arrest was 31.2 minutes, and selective cerebral perfusion was 65.3 minutes, with low rates of reoperation and prolonged intubation.

    Conclusions:

    • The trifurcated graft technique is associated with low rates of perioperative mortality, temporary neurologic dysfunction, and stroke.
    • This method may reduce cerebral embolization by avoiding direct aortic arch instrumentation for perfusion.
    • The technique allows for complete arch coverage and facilitates elephant trunk placement if needed.