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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Aortic arch repair: lessons learned over three decades at Baylor College of Medicine

Arsalan Amin1, Ginger M Etheridge1, Hiruni S Amarasekara1

  • 1Baylor College of Medicine, Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Houston, TX, USA.

The Journal of Cardiovascular Surgery
|May 27, 2022
PubMed

Insights

This study details advancements in open aortic arch repair techniques over three decades, improving patient outcomes. Key changes include shifting cannulation sites and evolving brain protection strategies for complex aortic arch disease.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Complex aortic arch disease presents significant surgical challenges, carrying high risks of mortality and stroke.
  • Over 3000 aortic arch repairs have been performed by the single-practice service since 1990.
  • Surgical techniques for open aortic arch repair have undergone substantial evolution over the past thirty years.

Purpose of the Study:

  • To describe the progression of technical approaches in open aortic arch repair.
  • To highlight advancements in surgical strategies and brain protection during these demanding procedures.

Main Methods:

  • Shift from femoral artery cannulation to innominate and axillary artery cannulation.
  • Transition from retrograde cerebral perfusion to antegrade cerebral perfusion for enhanced brain protection.
  • Evolution of brain protection from profound hypothermia (≤14 °C) to moderate hypothermia (22-24 °C) during circulatory arrest.

Main Results:

  • The evolution in cannulation and perfusion strategies facilitates management of complex arch repairs.
  • Modified hypothermia protocols represent a significant advancement in brain protection during aortic arch surgery.
  • Surgical approaches encompass a range of aortic pathologies including dissections and aneurysms, often involving reoperative sternotomy.

Conclusions:

  • Continuous refinement of surgical techniques, including cannulation and cerebral protection, has improved open aortic arch repair.
  • Modern approaches allow for more effective treatment of complex aortic arch disease, potentially reducing associated risks.
  • The described evolution reflects a commitment to advancing the standard of care for aortic arch pathologies.

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