Surgical repair of left-sided cervical aortic arch aneurysm

Abstract

Objective To summarize our experience of surgical repair for cervical aortic arch(CAA) aneurysm and evaluate early and midterm results of these patients. Methods From January 2010 to December 2014, 22 patients with left-sided CAA aneurysm admitted in our center. There were 6 male and 16 female patients with a mean age of(34.09±13.14) years. Comorbidities included pseudocoarctation in 9 patients, hypertension in 4 patients, and aortic valve insufficiency, Stanford type B aortic dissection and middle cerebral artery aneurysm each had 1 patient. All of the patients underwent surgical aortic arch reconstruction using artificial graft replacement. Among them, 4(4/22, 18.18%) were performed under moderate hypothermic circulatory arrest(MHCA) combined with selective antegrade cerebral perfusion(SACP) via a median sternotomy, and concomitant aortic valve replacement(AVR) was implemented in 1 patient. 18(18/22, 81.82%) were performed via posterolateral left thoracotomy through the 4th intercostal space, and adjunct methods applied included partial CPB and simple clamping in 10 and 8 of these patients respectively. Results The average mechanical ventilation time and ICU stay time was(13.05±4.73) h and(19.14±8.08) h respectively. 1 patient required repeat thoracotomy for bleeding, 1 patient with delayed wound healing and 1 patient suffered transient liver dysfunction. There were no in-hospital deaths. Mean follow-up time was 34.73 months, and 3 patients were lost during follow-up. There were no late deaths during follow-up. Conclusion Repair of CAA is indicated for the patients with arch aneurysm formation. According to the locations and types of aneurysms and other concomitant proximal cardiovascular diseases, performing one-stage surgical aortic arch reconstruction with individualized incisions, adjunct methods and operative procedures can obtain satisfactory clinical outcomes in patients with CAA aneurysm. Key words: Cervical aortic arch; Aortic arch malformation; Aneurysm; Cardiac surgical procedures