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Published on: March 28, 2025
165
Branch-first technique with continuous perfusion in aortic arch repair-our initial experience
Lalit Kapoor1, Dhiraj Barman1, Sayyed Azhar Salim Ahmed1
1Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India.
Indian Journal of Thoracic and Cardiovascular Surgery
|March 27, 2025
Summary
The branch-first technique (BFT) for aortic arch replacement avoids deep hypothermia and reduces surgery times. This innovative approach shows promise for improved patient outcomes in complex aortic arch repairs.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Aortic arch replacement traditionally involves deep hypothermia and circulatory arrest, posing significant risks.
- Reducing cardiopulmonary bypass (CPB) and ischemic times is crucial for improving patient outcomes.
Observation:
- The branch-first technique (BFT) was employed in three diverse aortic arch replacement cases.
- BFT involves sequential supra-aortic trunk reconstruction with continuous perfusion, utilizing a custom trifurcation graft.
- This technique avoids deep hypothermia and global circulatory arrest.
Findings:
- BFT was successfully implemented in all three cases, including two with aortic root replacement.
- Mean CPB time was 211 minutes, and mean aortic cross-clamp (ACC) time was 101 minutes.
- No perioperative complications, neurodeficits, stroke, or paresis were reported; patients were extubated on postoperative day 1.
Implications:
- BFT offers a promising alternative for aortic arch replacement, potentially reducing surgical stress and improving outcomes.
- The technique simplifies the surgical field, potentially enhancing operative ease and reducing overall procedure time.
- Further investigation with larger patient cohorts is warranted to establish BFT as a routine approach for aortic arch procedures.
