Abstract
BackgroundThe surgical approach to pathologies of the Ascending Thoracic Aorta (ATA) that compromise aortic root and the aortic arch is currently one of the most complex interventions in the spectrum of cardiac surgery, where circulatory arrest with cerebral perfusion plays an important role for Success postoperative and patient survival.Case presentationWe present the case of a 57-year-old patient with the only history of arterial hypertension and an ATA Aneurysm that compromised segment of the aortic root up to segment 2 of the aortic arch. A successful Bentall surgery was performed, debranching supra-aortic vessels with Total Circulatory Arrest with Deep Hypothermic Cerebral Perfusion-Antegrade Bilateral.ConclusionsWith the advent of new anesthetic and neuroprotection techniques, perioperative imaging protocols, advanced hemodynamic monitoring, and invaluable advances in perfusion and Extracorporeal Circulation with circulatory arrest, they have made this surgical challenge a valuable tool for today’s cardiovascular surgeon.
Highlights
The surgical approach to pathologies of the Ascending Thoracic Aorta (ATA) that compromise aortic root and the aortic arch is currently one of the most complex interventions in the spectrum of cardiac surgery, where circulatory arrest with cerebral perfusion plays an important role for Success postoperative and patient survival.Case presentation: We present the case of a 57-year-old patient with the only history of arterial hypertension and an ATA Aneurysm that compromised segment of the aortic root up to segment 2 of the aortic arch
Ascending aorta and aortic arch surgery is currently one of the most complex surgical interventions in the spectrum of cardiac surgery, where cardiac and circulatory arrest play an important role in the post-surgical success and patient survival
TCADHCP-AB was used through the right axillary and left carotid artery, providing constant perfusion to the brain during arch surgery and minimally reducing cerebral ischemic time; likewise, we associated it with profound hypothermia (< 28 °C) that allowed an acceptable alteration of the internal environment, less bleeding and greater neuroprotection
Summary
With the advent of new anesthetic and neuroprotection techniques, perioperative imaging protocols, advanced hemodynamic monitoring, and invaluable advances in perfusion and Extracorporeal Circulation (EC) with circulatory arrest, they have made this surgical challenge a valuable tool for today’s cardiovascular surgeon. Hybrid therapy has been gaining territory in this segment of the aorta, and its main advantage is the non-use of hypothermic brain perfusion strategies, which, as we know, is associated with a range of perioperative complications that cast a shadow on the prognosis of the patient [1]. As long as the safety of these novel techniques is not proven, the surgical territory of the aortic arch is today called “The last frontier of cardiac surgery”. Subclavian Artery; LSA: Left Subclavian Artery; RCa.A: Right Carotid Artery; LCa.A: Left Carotid Artery; DTA: Descending Thoracic Aorta
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