[Total Arch Replacement with Brain Isolation Technique for Arch Aneurysm with Shaggy Aorta]

Area of Science:

• Cardiovascular Surgery
• Neurosurgery
• Vascular Medicine

Background:

• Shaggy aorta with mobile atheromatous plaque is a risk factor for cerebral infarction during aortic arch surgery.
• The brain isolation technique aims to prevent embolic stroke during procedures involving atheromatous aorta or cardiopulmonary bypass.
• Cerebral infarction poses a significant risk in patients undergoing aortic arch surgery.

Purpose of the Study:

• To evaluate the efficacy of the brain isolation technique in preventing embolic stroke during total arch replacement in patients with aortic arch aneurysm and shaggy aorta.

Main Methods:

• Four patients with aortic arch aneurysm and shaggy aorta underwent total arch replacement using the brain isolation technique between 2016 and 2020.
• Antegrade selective cerebral perfusion was established before systemic cardiopulmonary bypass.
• The frozen elephant technique was employed for total arch replacement in all cases.

Main Results:

• No operative mortality was observed in the study cohort.
• All patients were discharged without major neurological complications.
• The brain isolation technique was successfully implemented in all four cases.

Conclusions:

• The brain isolation technique is a valuable adjunctive method for preventing embolic stroke in patients undergoing total arch replacement for aortic arch aneurysm with a shaggy aorta.
• This technique may reduce the incidence of neurological complications in high-risk surgical cases.
• Further research can explore broader applications of this technique in complex aortic surgeries.