Selective Heart, Brain and Body Perfusion in Open Aortic Arch Replacement

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Medical Devices

Background:

• Open aortic arch replacement is challenging, particularly for post-dissection aneurysms and redo procedures.
• Minimizing perfusion-related risks is crucial in these complex surgeries.
• Optimal perfusion strategies are needed for high-risk aortic arch operations.

Purpose of the Study:

• To report experience with a simultaneous selective perfusion strategy for open aortic arch replacement.
• To ensure optimal perfusion of the heart, brain, and body during complex aortic arch surgeries.
• To evaluate the safety and efficacy of this perfusion technique in high-risk patients.

Main Methods:

• Utilized a specially configured heart-lung machine with centrifugal and roller pumps for selective cerebral perfusion.
• Employed femoral or right axillary artery cannulation.
• Implemented simultaneous selective perfusion of the brain, heart, and lower body during circulatory arrest and distal arch anastomosis.

Main Results:

• Successfully treated 18 patients from October 2012 to November 2015.
• No heart-lung machine or cannulation-related complications occurred.
• One temporary neurological deficit resolved; no permanent neurological deficits or end-organ dysfunction were observed.

Conclusions:

• The described perfusion strategy is effective for complex open aortic arch replacement, including redo procedures.
• Simultaneous selective perfusion of brain, heart, and lower body ensures optimal organ protection.
• This technique offers excellent outcomes in high-risk aortic surgery patients.