Total aortic arch replacement surgery with a Core temperature of 34 °C

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Traditional aortic arch replacement necessitates deep hypothermia (22-28°C) and circulatory arrest, leading to common neurological complications.
• Hypothermia and hypoperfusion during aortic arch surgery pose risks to the nervous system, including brain and spinal cord damage.
• There is a critical need for improved surgical techniques to mitigate these risks in aortic arch replacement procedures.

Observation:

• A modified total aortic arch replacement technique was performed at a core temperature of 34°C in four patients (3 male, 1 female; aged 48-67).
• All patients presented with Stanford type A aortic dissection requiring emergency aortic sinus remodeling, ascending aortic replacement, modified aortic arch replacement, and elephant trunk stenting.
• The surgical approach involved a higher operating temperature and reduced circulatory arrest time compared to traditional methods.

Findings:

• No neurological complications were observed in any of the four patients post-surgery.
• Follow-up exceeding one month revealed no instances of aortic valve regurgitation or anastomotic leak.
• The technique successfully increased operating temperature by 6-12°C and reduced circulatory arrest time by 18-28 minutes.

Implications:

• This technique demonstrates feasibility and safety, offering a promising alternative for managing aortic dissection and aneurysm.
• The higher operating temperature and reduced circulatory arrest time contribute to improved patient outcomes and fewer neurological complications.
• This approach is particularly beneficial for surgeons gaining experience in aortic arch replacement surgery, enhancing safety and learning curves.