Technique and rationale for branch-first total aortic arch repair

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Aortic arch repair presents significant challenges due to the critical nature of its branches.
• Traditional methods may involve prolonged circulatory arrest and hypothermia, increasing risks.

Purpose of the Study:

• To describe the technique and rationale for a novel branch-first total aortic arch repair.
• To highlight the benefits of this approach in preserving organ perfusion.

Main Methods:

• Utilizes serial clamping, reconstruction, and reperfusion of each arch branch.
• Employs a specialized trifurcation graft with a side port for continuous antegrade cerebral perfusion.
• Involves excision of diseased aorta and replacement with a Dacron graft.

Main Results:

• Enables total aortic arch repair without global cerebral circulatory arrest or excessive hypothermia.
• Significantly shortens distal organ and cardiac ischemic times.
• Reduces the risk of air and particulate embolization during repair.

Conclusions:

• Branch-first total aortic arch repair facilitates continuous antegrade cerebral perfusion.
• Shortens distal organ and cardiac ischemic times, enhancing patient safety.
• Provides unobstructed access to the entire diseased aortic arch for comprehensive repair.