Total arch replacement using a 4-branched vascular graft without circulatory arrest

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Aortic arch pathologies require complex surgical interventions.
• Maintaining cerebral and organ perfusion during aortic arch repair is critical.
• Current techniques face challenges in achieving optimal perfusion and minimizing ischemia.

Purpose of the Study:

• To describe a refined surgical technique for total aortic arch replacement.
• To highlight the benefits of selective antegrade cerebral perfusion and a 4-branched graft.
• To demonstrate a method for minimizing organ ischemia during descending aorta repair.

Main Methods:

• Femoral artery cannulation and selective antegrade cerebral perfusion.
• Total aortic arch replacement using a 4-branched vascular graft.
• Implantation of an open stented graft into the descending aorta with moderate hypothermia (25°C) and balloon occlusion.

Main Results:

• The technique allows debranching of the arch first, followed by perfusion via the 4-branched graft.
• Antegrade cerebral perfusion is rapidly secured.
• Descending aorta arrest with balloon occlusion and early reperfusion minimizes organ ischemia.

Conclusions:

• This surgical approach provides effective brain protection and reduces ischemic times.
• The described technique facilitates complex aortic arch reconstruction and repair.
• It represents a valuable advancement in managing aortic arch diseases.