Warm aortic arch repair: A new approach

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Traditional aortic arch repair often necessitates hypothermic circulatory arrest and extensive surgical exposure.
• Minimally invasive techniques are sought to reduce surgical morbidity and improve patient outcomes in aortic arch surgery.

Purpose of the Study:

• To present a novel, streamlined approach for aortic arch repair.
• To evaluate the safety, feasibility, and reproducibility of warm aortic arch repair without hypothermic circulatory arrest or axillary/femoral cutdown.

Main Methods:

• The technique involves standard arterial lines, near-infrared spectroscopy, sternotomy, and cardiopulmonary bypass with central aortic cannulation.
• Antegrade cerebral perfusion (ACP) is administered under normothermia via the innominate artery using a needle cannula or balloon catheter.
• Aortic arch clamping is performed, with bilateral ACP used in select cases. Data collected from 2019-2024 on 153 patients.

Main Results:

• The majority of repairs were hemiarch (89.5%), with some zone 1 and zone 2 repairs.
• The approach became the standard of care by 2023, with increasing case volume.
• Technical success rate was 99.4%, with in-hospital mortality at 2.0% and disabling stroke at 1.3%.

Conclusions:

• Warm aortic arch repair without hypothermic circulatory arrest or axillary/femoral cutdown is safe, feasible, and reproducible.
• This technique represents a valid new approach for hemiarch and selected partial aortic arch repairs.
• The technique has been adopted by multiple surgeons and its indications are evolving.