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The cervical branch-first technique in complex resternotomy.

Michelle Ng¹, George Matalanis¹

¹Department of Cardiac Surgery, Austin Health, Melbourne, Australia.

JTCVS Techniques

|December 28, 2023

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The cervical branch-first technique enhances neuroprotection during complex aortic arch repair, especially in reoperative cases with hostile anatomy. This approach ensures uninterrupted cerebral perfusion, leading to promising patient outcomes.

Area of Science:

Cardiovascular Surgery
Thoracic Surgery
Vascular Surgery

Background:

The cervical branch-first technique represents a significant advancement in open aortic surgery.
It is specifically modified for patients with challenging mediastinal anatomy, reducing risks during sternal reentry.

Purpose of the Study:

To describe the intraoperative preparation and technique for cervical branch-first aortic arch repair.
To report the outcomes of four patients who underwent complex reoperative aortic surgery using this method.

Main Methods:

Detailed description of the cervical branch-first technique for intraoperative management.
Case series analysis of four patients undergoing complex reoperative aortic surgery.

Main Results:

Keywords:

branch-first total arch repair complex redo sternotomy redo open aortic surgery

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All four patients survived complex reoperative aortic surgery, including emergency cases and those requiring extracorporeal support.
No permanent neurological, ischemic, or peripheral arterial complications were observed; one late mortality occurred due to heart failure.

Conclusions:

The cervical branch-first technique provides superior, early neuroprotection during reoperative aortic surgery.
It establishes an independent cerebral perfusion circuit, crucial for complex procedures in compromised chests.
Initial outcomes are promising, with ongoing efforts to refine patient selection for this advanced technique.