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Beating heart arch replacement without circulatory arrest: a standardized surgical strategy
Jamie Romeo1, Anne Simone Lotfalla1, Erik P J Körver1
1Department of Cardiothoracic Surgery, Maastricht University Medical Centre+Maastricht, the Netherlands
Multimedia Manual of Cardiothoracic Surgery : MMCTS
|February 17, 2025
Summary
This study introduces a novel beating heart surgical technique for aortic arch repair, avoiding deep hypothermic circulatory arrest. This approach ensures continuous organ perfusion, enhancing patient safety during complex aortic arch surgeries.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Traditional aortic arch surgery often relies on deep hypothermic circulatory arrest (DHCA), antegrade brain perfusion, and cardioplegic arrest for organ protection.
- These methods carry potential risks and complications, necessitating exploration of alternative strategies.
Purpose of the Study:
- To present a surgical strategy for performing aortic arch surgery using a beating heart technique, thereby eliminating the need for circulatory arrest.
- To detail the methods for achieving continuous organ perfusion during aortic arch repair without systemic cooling or arrest.
Main Methods:
- Utilizing axillary artery cannulation for cardiopulmonary bypass and continuous cerebral perfusion.
- Implementing neurophysiological monitoring throughout the procedure.
- Employing femoral cannulation with an EndoReturn cannula and a Coda balloon catheter for visceral perfusion.
- Applying mild systemic cooling (28-32 °C).
Main Results:
- The presented technique allows for aortic arch surgery to be performed on a beating heart, obviating the need for deep hypothermic circulatory arrest.
- Continuous cerebral and visceral perfusion is maintained throughout the procedure, potentially reducing the risk of organ ischemia.
Conclusions:
- Beating heart aortic arch surgery without circulatory arrest is a feasible alternative to traditional methods.
- This strategy offers a promising approach for enhanced organ protection during complex aortic arch interventions.
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