Aortic arch replacement without circulatory arrest or deep hypothermia: the "branch-first" technique

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Cerebral morbidity remains a significant challenge in current aortic arch replacement procedures.
• Despite improvements in mortality rates, neurological complications persist.
• Existing techniques often necessitate circulatory arrest and profound hypothermia, increasing risks.

Purpose of the Study:

• To describe and evaluate the outcomes of a novel "branch-first" technique for aortic arch replacement.
• To assess the efficacy of this technique in reducing cerebral morbidity and improving survival.
• To present a method that avoids circulatory arrest and profound hypothermia.

Main Methods:

• The "branch-first" technique involves individual isolation and anastomosis of each arch branch to a perfused trifurcation graft.
• The procedure proceeds sequentially from the innominate to the left subclavian artery, maintaining continuous perfusion.
• Sixty-four patients underwent this technique between September 2005 and February 2014, including urgent cases and those with aortic dissection or aneurysms.

Main Results:

• Early mortality was low at 3.1% (2 patients).
• Permanent stroke occurred in only 1.6% of patients (1 patient).
• The technique demonstrated excellent survival and low cerebral morbidity, comparable to ascending aortic procedures.

Conclusions:

• The "branch-first" technique offers a promising approach to aortic arch surgery.
• It achieves excellent survival and low cerebral and vital organ morbidity.
• This method brings arch surgery outcomes closer to those of ascending aortic and root procedures.