Arch replacement using antegrade selective cerebral perfusion for shaggy aorta

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Aortic Surgery

Background:

• Shaggy aorta, characterized by atheromatous plaque, poses a significant risk of embolic stroke during aortic arch replacement.
• Managing shaggy aorta in patients undergoing complex aortic procedures is a critical clinical challenge.

Purpose of the Study:

• To evaluate the safety and efficacy of antegrade selective cerebral perfusion via axillary artery cannulation in patients with shaggy aorta undergoing total aortic arch replacement.
• To identify factors associated with outcomes and survival in this patient cohort.

Main Methods:

• Retrospective analysis of 63 patients who underwent total aortic arch replacement between 2005 and 2010.
• Preoperative contrast-enhanced computed tomography (CT) scanning to assess shaggy aorta.
• Analysis of operative data, including perfusion techniques and patient outcomes.

Main Results:

• Shaggy aorta was present in 54% of patients, predominantly in the aortic arch (41%).
• The antegrade selective cerebral perfusion technique was associated with a low incidence of stroke (3%) and operative mortality (2%).
• Shaggy descending aorta and age >75 years were identified as independent risk factors for late mortality.

Conclusions:

• Antegrade selective cerebral perfusion using axillary artery cannulation is a safe and effective method for protecting patients with shaggy aorta against embolism during arch replacement.
• Shaggy descending aorta is a significant predictor of reduced long-term survival after aortic arch surgery.