Branch-first technique with continuous perfusion in aortic arch repair-our initial experience

The branch-first technique (BFT) for aortic arch replacement eliminates deep hypothermia and global circulatory arrest, reducing cardiopulmonary bypass and ischemic times. We present our initial experience with BFT in such repairs at our centre. Three cases with diverse pathologies have been described where BFT was employed. The technique involves sequential clamping and reconstruction of each supra-aortic trunk (SAT) with continuous perfusion, facilitated by a custom-designed trifurcation graft and a dedicated pump head. Detailed patient profiles, echocardiographic findings, computed tomography (CT) scans and surgical procedures were outlined. BFT was successfully applied in all three, including two with root replacement, without perioperative complications. Mean cardiopulmonary bypass time (CPB) was 211 min, and mean aortic cross-clamp (ACC) time was 101 min. Patients were extubated on the 1st postoperative day with no neurodeficit. No instances of stroke, paresis or other complications were reported during the hospital stay (mean 7 days). Follow-up was uneventful. BFT shows promise in aortic arch replacement surgeries by avoiding unnecessary deep hypothermia, reducing CPB and ACC time. The overall time burden for surgery in arch repair is eliminated along with providing an excellent surgical field, enhancing the ease of operating and consequently resulting in excellent clinical outcomes. While further studies are required, especially with larger cohorts, BFT could become a routine approach for elective and emergency aortic arch procedures.