Proximal aortic perfusion for complex arch and descending aortic disease

Cannulation of the femoral artery is used routinely for hypothermic circulatory arrest operations on the aortic arch. A two-stage approach is advocated for combined arch and descending aortic disease. These methods are associated with important neurologic injury through embolism or malperfusion. We therefore changed to a central cannulation technique through extended left thoracotomy.

Eighteen patients with arch or combined pathologic conditions underwent one-stage repair with hypothermic circulatory arrest using ascending aortic cannulation and venous drainage from the pulmonary artery. Emergency operations were performed for bleeding or dissection. Cerebral and myocardial perfusion were restored during descending aortic replacement.

One elderly patient died of gastrointestinal hemorrhage after initial recovery (overall mortality 5.6%, range 0.14% to 27%, p = 0.05). One possible transient monoparesis occurred but without computed tomographic scan evidence of embolism. No other significant events and no morbidity occurred from the surgical methods.

Extended left thoracotomy with central cannulation allows safe one-stage replacement of the arch and descending aorta using anterograde cerebral perfusion. We believe that this method will reduce cerebral complications in arch and descending aortic operations.