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Central Partial Bypass Management Technique for Distal Arch Surgery.

Amanda Cornelius1, Krithika Ramaprabhu1, Elizabeth Stephens1

  • 1Cardiovascular Sugery, Mayo Clinic, Rochester, Minnesota.

The Journal of Extra-Corporeal Technology
|January 7, 2022
PubMed
Summary

A novel central partial bypass technique reliably manages perfusion during distal arch surgery for aneurysmal Kommerell's diverticulum (KD) and aberrant subclavian artery (ASA). This method ensures adequate blood flow, facilitating successful surgical repair with no early mortality.

Keywords:
Kommerell diverticulumaberrant subclavian artery.cardiaccardiopulmonary bypassvascular ring

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Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Thoracic Surgery

Background:

  • Distal arch surgery commonly uses circulatory arrest or left heart bypass for perfusion management.
  • Aneurysmal Kommerell's diverticulum (KD) and aberrant subclavian artery (ASA) present unique challenges in distal arch repair.
  • Effective perfusion strategies are crucial for patient outcomes in complex aortic arch procedures.

Purpose of the Study:

  • To introduce and evaluate a novel central partial bypass perfusion technique for aneurysmal KD and ASA repair.
  • To demonstrate the reliability and efficacy of this technique in managing perfusion during distal arch surgery.
  • To assess the early outcomes associated with this innovative perfusion strategy.

Main Methods:

  • A cohort of 12 adult patients with aneurysmal KD and ASA underwent distal arch repair via lateral thoracotomy.
  • A central partial cardiopulmonary bypass (CPB) was established using cannulation of the lower thoracic aorta and right atrium.
  • Ventilation provided upper body oxygenation, while CPB supported lower body gas exchange, maintaining specific arterial pressures and allowing native ejection.

Main Results:

  • The novel perfusion technique allowed for reliable management of blood flow during complex distal arch reconstruction.
  • Patients maintained adequate mean arterial pressure in both the femoral (>60 mmHg) and radial (>80 mmHg) arteries.
  • All patients were extubated on the same day of surgery, with no reported early mortality.

Conclusions:

  • Central partial bypass is a viable and effective perfusion strategy for distal arch surgery involving aneurysmal KD and ASA.
  • This technique facilitates safe and successful surgical repair, leading to excellent early clinical outcomes.
  • The described method offers a reliable alternative for perfusion management in challenging aortic arch pathologies.