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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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The aortic uncrossing procedure.

Carl L Backer1, Michael C Mongé2, William J Wallen1

  • 1Section of Pediatric Cardiothoracic Surgery, UK HealthCare Kentucky Children's Hospital, Lexington, Ky; Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, Ohio.

The Journal of Thoracic and Cardiovascular Surgery
|July 5, 2023
PubMed
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Aortic uncrossing effectively treats airway and esophageal compression in patients with a right aortic arch and circumflex aorta. This surgical procedure is safe and provides symptom relief.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Surgery
  • Thoracic Surgery

Background:

  • Vascular rings and circumflex aorta are rare congenital anomalies.
  • Diagnosis relies on cross-sectional imaging showing a right aortic arch posterior to the trachea.
  • Surgical intervention aims to relieve associated airway and esophageal compression.

Approach:

  • A retrospective review of patients undergoing aortic uncrossing from 2002 to 2022.
  • Preoperative assessment included computed tomography imaging and bronchoscopy.
  • Surgical techniques involved deep hypothermic circulatory arrest or antegrade cerebral perfusion.

Key Points:

  • Eleven pediatric patients (1.5-10 years) underwent aortic uncrossing for symptomatic vascular rings.
  • Symptomatic relief of airway and dysphagia was achieved in all patients.
Keywords:
airway compressioncircumflex aortaright aortic archvascular ring

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  • Complications were minimal, including one temporary tracheostomy and one aortic extension graft.

    • Conclusions:

    • Aortic uncrossing is a safe and effective treatment for airway and esophageal compression in selected patients.
    • The procedure can be performed using either deep hypothermic circulatory arrest or antegrade cerebral perfusion.
    • Meticulous surgical technique is crucial, especially regarding the esophagus and recurrent laryngeal nerves.