Abstract
BackgroundAortic arch reconstruction is associated with high neurological morbidity. Our purpose is to describe our experience using a 4-branched graft and selective antegrade brain perfusion (SABP) for total aortic arch replacement (TAR).MethodsWe retrospectively reviewed the medical records of 12 patients who received TAR, with or without ascending aorta replacement, with a 4-branched graft for Stanford type A dissection (n = 9) or aortic arch aneurysm (n = 3). In all patients surgery was performed with deep hypothermic circulatory arrest (DHCA) with or without retrograde brain perfusion, and selective antegrade brain perfusion (SABP) via the subclavian artery or axillary artery.ResultsThere were 8 males and 4 females with an average age of 63.14 years. Emergent operations were performed in 9 patients with acute type A aortic dissections. Of all 12 patients, 2 deaths occurred and 1 patient experienced lower extremity paraplegia resulting in an in-hospital mortality rate of 16.6% and a permanent neurological deficit rate of 8.3%.ConclusionsThe use of a 4-branched graft, hypothermic circulatory arrest, and SABP is a useful operative method for aortic arch replacement with acceptable morbidity and mortality.
Highlights
Aortic arch reconstruction is associated with high neurological morbidity
Aortic arch surgery is associated with significant morbidity and mortality, and neurologic dysfunction remains a major complication of operations that involve total aortic arch replacement (TAR)
Emergent operations were performed in 9 patients with acute type A aortic dissections involving the ascending aorta to the aortic arch, and among these 9 patients the inlet of the dissection was over the lesser curvature of aortic arch in 6 patients and distal to the left subclavian artery in the other 3 patients (Table 2)
Summary
Aortic arch reconstruction is associated with high neurological morbidity. Our purpose is to describe our experience using a 4-branched graft and selective antegrade brain perfusion (SABP) for total aortic arch replacement (TAR). Aortic arch surgery is associated with significant morbidity and mortality, and neurologic dysfunction remains a major complication of operations that involve total aortic arch replacement (TAR). SABP introduces the risk of embolization of atheromatous debris or air, but provides oxygenated blood to the brain and reduces pump time and the risk of hypothermia-related complications such as pulmonary insufficiency and coagulopathy [3,4,5]. Authors have reported TAR using a 4-branched prosthetic graft, SABP, and hypothermia is associated with good outcomes [11,12]
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