Related Experiment Video
Updated: Jun 28, 2025
O-Ring Aortic Banding Versus Traditional Transverse Aortic Constriction for Modeling Pressure Overload-Induced Cardiac Hypertrophy
Published on: October 6, 2022
Open aortic arch repair without circulatory arrest by frozen elephant trunk in Ishimaru zone 0
Ciro Bancone1, Alessandro Della Corte2, Federica Lo Presti1
1Department of Translational Medical Sciences, Unit of Cardiac Surgery, University of Campania "L. Vanvitelli", V. Monaldi Hospital, Via L. Bianchi, Naples, 80131, Italy.
Background:
Open arch surgery is technically demanding for the surgeon and surgically and biologically invasive for the patient, requiring a variably long period of hypothermic circulatory arrest.
Case Presentation:
Here we present a case of an elderly patient with chronic renal failure and multiple splanchnic artery disease successfully treated for a rupturing pseudoaneurysm of the aortic arch with a technique that we developed for particularly frail patients. The procedure includes: triple supra-aortic vessel perfusion; distal thoracic aorta antegrade perfusion; balloon endo-clamping of the descending aorta; and anastomosis of an off-the-shelf hybrid arch prosthesis in Ishimaru zone 0. These maneuvers allowed to maintain an extracorporeal circulation in the phase of distal anastomosis, instead of a period of circulatory arrest, employing just mild hypothermia: technical details are depicted and discussed also in comparison with other methods proposed in the literature.
Conclusions:
Being able to take advantage of both open surgery advancements and endovascular methods is the key to cardiovascular surgery success today in front of complex pathologies of the aorta: increasing safety and reducing invasiveness of therapeutic options may progressively extend surgical candidacy to the frailest patients.
