Bypass grafting and aneurysmorrhaphy for aortic arch aneurysms

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery

Background:

• Aneurysms of the aortic arch pose significant surgical challenges.
• Traditional repair methods often involve systemic heparinization and cardiopulmonary bypass, carrying inherent risks.

Purpose of the Study:

• To evaluate the efficacy and safety of a novel technique for aortic arch aneurysm repair.
• To assess the outcomes of permanent aortic arch bypass grafting combined with simultaneous aneurysmorrhaphy, excision, or exclusion without systemic heparinization or cardiopulmonary bypass.

Main Methods:

• The study involved 5 patients with aortic arch aneurysms.
• A technique combining permanent aortic arch bypass grafting with simultaneous aneurysm management (aneurysmorrhaphy, excision, or exclusion) was employed.
• Systemic heparinization, cardiopulmonary bypass, and external bypass shunting were avoided.

Main Results:

• The technique was successfully used in all 5 patients.
• No cerebral vascular accidents, bleeding diatheses, or distal embolization occurred.
• Two deaths were recorded: one early (10 days) from myocardial infarction and one late (over one year) from unrelated causes.
• Follow-up extended up to seven years.

Conclusions:

• Permanent aortic arch bypass grafting with simultaneous aneurysm management is a viable and safe alternative.
• The absence of systemic heparinization and cardiopulmonary bypass may reduce associated complications.
• Preoperative assessment including carotid and coronary angiography is crucial for patients with potential occlusive disease.