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Multiple Cardiac Diseases Involving the Aortic Arch: Beating Heart Debranching, and Normothermic Arch Replacement: A

Alessandro Motta1, Cristian Scarpari1, Ermelinda Borrelli1,2

  • 1UO Cardiochirurgia, APSS-Ospedale Santa Chiara, Largo Medaglie d'Oro, 38100 Trento, Italy.

Journal of Clinical Medicine
|February 10, 2024
PubMed

Insights

This study introduces a "debranching first" surgical technique for complex aortic arch disease. The innovative approach minimizes ischemia, reducing risks and potentially offering a safer option for high-risk patients.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Aortic arch disease conventional management carries high morbidity and mortality.
  • Optimizing neuroprotection, perfusion, and myocardial protection strategies remain challenging.
  • Aortic arch replacement requires advanced surgical techniques to improve outcomes.

Purpose of the Study:

  • To evaluate the safety and efficacy of a novel
  • debranching first
  • surgical technique for aortic arch disease.
  • To assess the impact of this technique on patient outcomes, including ischemia time and complications.
  • To determine the feasibility of this approach in patients with complex cardiac comorbidities.

Main Methods:

  • A case series of 12 patients undergoing surgical management for aortic arch disease.
  • Implementation of a
  • debranching first
  • technique involving supra-aortic vessel debranching on a beating heart.
  • Subsequent cardiac and distal aortic arch repair steps to minimize ischemia.

Main Results:

  • Six patients underwent aortic root replacement (Bentall or David procedure).
  • Mean nasopharyngeal temperature was 34°C with a mean cardiocirculatory arrest time of 14.3 minutes.
  • Early mortality was 8.3% (1 patient), with no permanent neurologic events.

Conclusions:

  • The
  • debranching first
  • technique may reduce hypothermia, cardiopulmonary bypass, and myocardial arrest times.
  • This approach could be a viable surgical option for complex aortic disease with concomitant cardiac conditions.
  • The technique shows promise for improving outcomes, even in high-risk surgical candidates.

Keywords:
aortic arch replacementcerebral perfusiondebranchingfrozen elephant trunk

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