Abstract
Aortic arch replacement is formidable cardiac surgery that is fraught with complications like brain injury, coagulopathy along with high mortality. Over the past several years, various techniques like deep hypothermic circulatory arrest, retrograde cerebral perfusion, and selective antegrade cerebral perfusion along with branched graft techniques have been developed with better early outcomes. We share our experience of successful replacement of ascending and total aortic arch in a 60 years old female, who presented with ascending and aortic arch aneurysm.
Highlights
Aortic arch replacement is one of the most challenging operations in cardiovascular surgery
Innominate artery was divided proximal to the graft, arch end was sutured; left carotid artery was divided and separate cannula was used for selective antegrade cerebral perfusion into the left common carotid artery
A primary disadvantage of using deep hypothermic circulatory arrest is the prolonged bypass times required for cooling and rewarming which adds significantly to the morbidity associated with these procedures, especially coagulopathy-related bleeding[2,3], organ dysfunction like stroke and death[4,5,6]
Summary
Aortic arch replacement is one of the most challenging operations in cardiovascular surgery. Innominate artery was divided proximal to the graft, arch end was sutured; left carotid artery was divided and separate cannula was used for selective antegrade cerebral perfusion into the left common carotid artery. Proximal descending aorta clamped and femoral perfusion continued along with selective antegrade cerebral perfusion (SACP) throughout the procedure. Ascending aorta from sinotubular junction to aortic arch, just distal to the origin of left subclavian artery was excised. Dacron graft (24mm), with 4 branches, was anastomosed distally to descending aorta and proximally to sinotubular junction. Total cardiopulmonary bypass time was 243 minutes and aortic cross clamp time was 133 minutes and antegrade cerebral perfusion time was 138 minutes. Post operatively patient required very minimal amount of inotropic support and was extubated morning. She has been on regular follow up and her status has been unremarkable
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