Aortic Arch Replacement without Deep Hypothermic Circulatory Arrest

Area of Science:

• Cardiovascular Surgery
• Thoracic Aortic Disease
• Aortic Valve Disease

Background:

• A 60-year-old male patient presented with a thoracic aortic aneurysm without rupture.
• The patient also had severe nonrheumatic aortic valve insufficiency and unstable angina.

Observation:

• Surgical intervention was performed, encompassing multiple complex procedures.
• The surgery involved resection and reconstruction of the ascending aorta and aortic arch with a tube graft.
• Aortic valve replacement was done using a biological prosthesis.
• Coronary artery bypass grafting with two distal anastomoses was also performed.

Findings:

• The entire surgical procedure was completed using total cardiopulmonary bypass.
• Moderate hypothermia was employed, avoiding deep hypothermic circulatory arrest.
• Dual concurrent cannulation of the subclavian and femoral arteries facilitated the procedure.

Implications:

• This case demonstrates a successful multi-stage surgical approach for complex aortic and coronary disease.
• The use of moderate hypothermia and dual cannulation highlights alternative strategies in cardiopulmonary bypass.
• Such complex reconstructions are feasible and can address concurrent life-threatening cardiovascular conditions.