[Aortic arch replacement placing priority on cardiac and cerebral reperfusion]

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Aortic arch replacement is a complex procedure with risks of cardiac and neurological complications.
• Traditional methods may involve prolonged periods of ischemia and require direct cannulation of arch branches.

Observation:

• Two patients underwent aortic arch replacement using a modified "arch first technique" prioritizing cardiac and cerebral reperfusion.
• One patient had a history of cerebral infarction and ischemic heart disease; the other had severe left common carotid artery stenosis.

Findings:

• The modified technique involved proximal anastomosis during core cooling, followed by brachiocephalic artery reconstruction under deep hypothermic circulatory arrest.
• Cardiac and cerebral perfusion was restarted before completing the distal anastomosis.
• Both patients experienced successful outcomes with no postoperative cardiac or neurological complications.

Implications:

• This modified approach may reduce the duration of brain ischemia and deep hypothermia.
• Eliminating direct cannulation of aortic arch branches and separate brain perfusion circuits simplifies the procedure.
• The technique shows promise for improving safety and outcomes in aortic arch replacement surgeries.