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Updated: Jul 6, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
[Aortic arch replacement placing priority on cardiac and cerebral reperfusion]
Kazuyoshi Doi1, Y Kawachi, M Takamatsu
1Department of Cardiovascular Surgery, Fukuoka Wajiro Hospital, Fukuoka, Japan.
Insights
This modified aortic arch replacement technique prioritizes cardiac and cerebral reperfusion, successfully preventing complications in two patients. The method minimizes brain ischemia and deep hypothermia duration.
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.
Abstract:
In this report, aortic arch replacement was performed successfully in 2 cases with our modified method placing priority on the cardiac and cerebral reperfusion, resulting in no postoperative cardiac or neurological complication. One was a 63-year-old man with old cerebral infarction and ischemic heart disease, and the other was a 72-year-old man with severe stenosis of the left common carotid arteries. Our method is similar to so-called "arch first technique". First, the ascending aorta is clamped and proximal anastomosis is accomplished during core cooling, followed by reconstruction of the brachiocephalic arteries under deep hypothermic circulatory arrest. Then perfusion of the heart and brain is restarted, while distal anastomosis is performed. It was proved that the method had several possible advantages such as minimized duration of brain ischemia and deep hypothermia, and elimination of direct cannulation to the branches of the aortic arch and a separate perfusion circuit for the brain.
