[Distal aortic repair after aortic arch replacement]

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Context:

• Distal aortic repair, including descending thoracic aorta (DTA) and thoracoabdominal aorta (TAA) replacement, often requires exposure of the proximal aorta after aortic arch replacement.
• Exposure of the proximal aorta can be challenging without an "elephant trunk" (ET) graft, potentially necessitating deep hypothermic circulatory arrest (DHCA).

Purpose:

• To evaluate the necessity of DHCA in distal aortic repair following aortic arch replacement.
• To compare outcomes between patients undergoing distal aortic repair with and without the ET technique.

Summary:

• A study of 17 patients undergoing distal aortic repair after aortic arch replacement compared those requiring DHCA (n=5) with those who did not (n=12) using the ET technique.
• Patients requiring DHCA (OP (+) group) had significantly longer extracorporeal circulation times (415 min vs. 267 min).
• While no in-hospital deaths or major complications occurred in either group, paraplegia and renal failure requiring hemodialysis were observed only in the OP (+) group.

Impact:

• The ET technique simplifies proximal aorta exposure, potentially avoiding DHCA in distal aortic repair after aortic arch replacement.
• Implementing the ET procedure may lead to improved operative results and reduced complication rates in complex aortic surgeries.