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"Head First" approach streamlines aortic arch replacement
Bo Chang Brian Wu1,2, Drake S Rosenberg2, Meghan Skalicky2
1Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo.
JTCVS Techniques
|February 9, 2026
Summary
The "Head First" graft technique shows acceptable outcomes for complex aortic arch repair, prioritizing cerebral protection and efficient reconstruction. This method may improve technical feasibility in aortic replacement surgeries.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- The "Head First" graft technique is increasingly favored for aortic replacement.
- Evaluating its safety and efficacy in complex aortic arch repair is crucial.
Purpose of the Study:
- To assess the performance and safety of the "Head First" technique in zone 2 or more extensive aortic arch replacement.
- To focus on operative efficiency, cerebral protection, and outcomes in open arch repair.
Main Methods:
- Retrospective review of 150 patients undergoing "Head First" aortic arch repair (August 2020 - March 2025).
- Comparison of perioperative variables between acute type A aortic dissection and elective repair groups.
- Logistic regression analysis to identify stroke risk factors.
Main Results:
- Overall disabling stroke rate was 10.7%, and 30-day mortality was 16.7%.
- Patients with acute type A aortic dissection experienced longer bypass and circulatory arrest times but similar stroke rates compared to elective cases.
- Male gender was found to be independently protective against stroke.
Conclusions:
- The "Head First" approach offers acceptable outcomes for complex aortic arch replacement.
- It facilitates effective cerebral protection and efficient reconstruction, potentially improving technical feasibility.
