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Related Concept Videos

Aneurysm III: Interprofessional Care01:26

Aneurysm III: Interprofessional Care

Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...

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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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Aortic arch replacement with a trifurcated graft.

David Spielvogel1, Christian D Etz, Daniel Silovitz

  • 1Section of Cardiothoracic Surgery, New York College of Medicine, Westchester Medical Center, Valhalla 10595, USA. spielvogeld@wcmc.com

The Annals of Thoracic Surgery
|January 30, 2007
PubMed
Summary

A trifurcated arch graft with hypothermic circulatory arrest (HCA) and selective antegrade cerebral perfusion (SCP) is a safe and versatile technique for aortic arch aneurysm repair. This method demonstrated an 8.7% adverse outcome rate in 150 patients.

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Published on: May 21, 2017

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Aortic arch aneurysms pose significant surgical challenges.
  • Hypothermic circulatory arrest (HCA) and selective antegrade cerebral perfusion (SCP) are critical for brain protection during aortic arch surgery.

Purpose of the Study:

  • To evaluate the efficacy and safety of using a trifurcated arch graft combined with HCA and SCP for aortic arch replacement.
  • To analyze outcomes in patients undergoing complex aortic arch reconstructions.

Main Methods:

  • A retrospective review of 150 consecutive patients undergoing aortic arch replacement with a trifurcated graft and HCA/SCP.
  • Axillary artery cannulation, HCA with SCP via the trifurcated graft, and detailed analysis of patient demographics, comorbidities, and surgical procedures.
  • Use of an elephant trunk in 144 patients with varying distal extensions.

Main Results:

  • An overall adverse outcome rate of 8.7% (13 of 150 patients), including 7 hospital deaths and 6 permanent strokes.
  • Low rates of temporary neurologic dysfunction (7 patients) and transient renal failure requiring dialysis (9 patients).

Conclusions:

  • The trifurcated arch graft in conjunction with HCA and SCP is a safe and versatile approach for aortic arch aneurysm repair.
  • This technique facilitates complex aortic arch reconstructions with acceptable morbidity and mortality.