A Strategy for Minimizing Circulatory Arrest Duration in Complex Aortic Arch Procedures.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Aortic arch pathologies pose significant surgical challenges, often necessitating prolonged circulatory arrest and deep hypothermia.
• Deep hypothermia in aortic arch surgery is associated with potential complications and sequelae.
• Current surgical strategies require complex measures for cerebral, visceral, and myocardial protection.

Purpose of the Study:

• To evaluate the feasibility of a modified perfusion technique for total aortic arch replacement.
• To reduce the duration of circulatory arrest during aortic arch surgery.
• To eliminate the need for deep hypothermia in aortic arch repair procedures.

Main Methods:

• A retrospective observational study involving 15 patients with type A aortic dissection undergoing total arch replacement with a frozen elephant trunk.
• Utilized a y-branched arterial cannula (ThruPort™) for cardiopulmonary bypass via right axillary and femoral arteries.
• Employed a modified perfusion technique allowing endo-clamping of the frozen elephant trunk stent and lower body perfusion.

Main Results:

• Mean circulatory arrest time was significantly reduced to 8.1 ± 4.2 minutes.
• Surgery was performed at a mean lowest body temperature of 28.9 ± 2.3 °C (moderate hypothermia).
• Achieved a 100% rate for 30-day survival, with mean ICU and hospital stays of 18.3 and 23.8 days, respectively.

Conclusions:

• The modified perfusion technique enables aortic arch surgery with circulatory arrest times under ten minutes.
• This approach avoids deep hypothermia, allowing surgery under moderate hypothermia.
• Further research is needed to confirm the clinical benefits of this technique for patients.