Open Aortic Arch Repair: State-of-the-Art and Future Perspectives

Surgical procedures for the treatment of complex aortic arch pathology remain among the most challenging cardiovascular operations, incurring considerable risk for death and stroke. The purpose of this article is to describe the evolution of our approach to open repair of the aortic arch. Our arteri...

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Bibliographic Details
Published in:Seminars in thoracic and cardiovascular surgery 2013, Vol.25 (2), p.107-115
Main Authors: Ouzounian, Maral, MD, PhD, LeMaire, Scott A., MD, Coselli, Joseph S., MD
Format: Article
Language:English
Subjects:
aneurysm
Aorta, Thoracic - physiopathology
Aorta, Thoracic - surgery
aortic arch
aortic operation
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - methods
Blood Vessel Prosthesis Implantation - trends
Cardiothoracic Surgery
Catheterization, Peripheral - trends
cerebral perfusion
Cerebrovascular Circulation
Forecasting
Humans
Perfusion - trends
Postoperative Complications - etiology
Risk Factors
Treatment Outcome
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Summary:Surgical procedures for the treatment of complex aortic arch pathology remain among the most challenging cardiovascular operations, incurring considerable risk for death and stroke. The purpose of this article is to describe the evolution of our approach to open repair of the aortic arch. Our arterial cannulation strategy has shifted from femoral and direct aortic to right axillary and more recently innominate artery cannulation. This transition has facilitated the administration of continuous antegrade cerebral perfusion and more moderate levels of hypothermia during complex repairs. Modifications in surgical technique, including arch reconstruction with the trifurcated graft, and the classical and frozen elephant trunk techniques have simplified the conduct of the operation. Experimental and clinical research supporting the evolution of our approach is discussed in this paper.
ISSN:1043-0679
1532-9488
DOI:10.1053/j.semtcvs.2013.07.001