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Aneurysm III: Interprofessional Care01:26

Aneurysm III: Interprofessional Care

Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...

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Warm aortic arch repair: A new approach.

Shinichi Fukuhara1, Robert B Hawkins1, Gorav Ailawadi1

  • 1Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.

JTCVS Techniques
|July 11, 2025
PubMed
Summary

This study introduces a safe and effective warm aortic arch repair technique, avoiding hypothermic circulatory arrest and major vessel cannulation. This streamlined approach offers a reproducible option for various aortic arch pathologies.

Keywords:
antegrade cerebral perfusionhemiarch aortic repairhypothermic circulatory arrestpartial aortic arch repair

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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.