Alternative Approach for Cerebral Protection during Complex Aortic Arch and Redo Surgery

Journal of Cardiovascular Development and Disease

Christoph A. Nienaber¹  Massimo Capoccia¹  Maziar Mireskandari¹  Nicholas J. Cheshire¹  Ulrich P. Rosendahl¹  Michael Sabetai²  Christopher Young² 

[1] Aortic Centre, Royal Brompton Hospital, London SW3 6NP, UK;Cardiac Surgery, Guy’s & St. Thomas’ Hospital, London SE1 9RS, UK;

关键词: arch surgery;    cerebral protection;    redo surgery;   

DOI  :  10.3390/jcdd8080086

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown