Abstract
Total arch replacement remains a very demanding surgical procedure. It can be associated with reasonable long-term outcomes but carries serious perioperative complications. Aortic arch surgery has progressed in recent years to a wider adoption of reproducible and reliable techniques. Conventional open, surgical aortic arch replacement is currently offered to the majority of patients, although hybrid and wholly endovascular techniques are gaining popularity. With regards to open arch replacement, the nuances of surgical technique, the mode of cannulation and the optimal cerebral protection protocols remain a matter of debate. We propose an alternative cannulation approach facilitated by the cooperation between cardiac and vascular surgeons. A three-way arterial cannulation including both carotid arteries and the femoral artery (or ascending aorta) is the key feature of this approach. A case series of complex patients is presented to show both the feasibility and relative safety of a standardised new approach with a 100% technical success rate and a 16% 30-day mortality. The three-way cannulation approach may have a role to play for complex and extensive procedures requiring prolonged cerebral protection. We believe that a shared skill set from cardiac and vascular specialists is essential for the safe management and successful outcomes using this adaptive technique.
Highlights
Total arch replacement surgery continues to be a challenge
Durability after a successful total arch repair has been shown to be acceptable, but it still carries the risk of potentially devastating perioperative complications
Since the early attempts [1,2], aortic arch surgery has progressed with multiple technical adaptations
Summary
Total arch replacement surgery continues to be a challenge. Since the early attempts [1,2], aortic arch surgery has progressed with multiple technical adaptations. Classic conventional aortic arch replacement is currently being offered to the majority of patients, but hybrid and endovascular techniques have gained popularity. These less invasive approaches can often be as technically challenging as open surgery with stroke and endo-leaks as early limiting factors and less favourable mid- to long-term results [3]. At the present time, reported mid-term outcomes and intra-operative complication rates with both hybrid and conventional aortic arch surgery remain heterogeneous and depend on centre experience and patient suitability [4]
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