Total Aortic Arch Replacement. Does a management protocol impact the results?

• Published in: Revista medíca de Chile 2023-12, Vol.151 (12), p.1586
• Main Authors: Flores A, Emilio, Gaete C, Paula, Pérez B, Enrique, Fullerton M, Demian, Revollo, Olivia, Fermandois C, Magdalena, Cáceres, Matías, Morales, Isaías, Fuentes, Daniel, López, Marisol
• Format: Article
• Language: Spanish
• Subjects: Adult; Aged; Aged, 80 and over; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - surgery; Aortic Dissection - diagnostic imaging; Aortic Dissection - surgery; Blood Vessel Prosthesis Implantation - methods; Chile; Clinical Protocols; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Time Factors; Treatment Outcome
• ISSN: 0717-6163; 0717-6163
• DOI: 10.4067/s0034-98872023001201586

Aortic arch surgery is a surgical challenge due to its technical complexity and brain and body protection requirements. To describe the surgical protocol and the short and long-term results of aortic arch replacement surgery in a center in the metropolitan region of Santiago, Chile. Retrospective descriptive study from April 2015 to August 2022. Elective, urgent, and emergency patients were included, with diagnoses of arch aneurysm and acute or chronic type I and II DeBakey aortic dissection. Arterial cannulation at the brachiocephalic trunk, right axillary artery, or directly into the true lumen of the aortic dissection with Seldinger technique, guided by epiaortic and transesophagic ultrasound. Deep hypothermia at 24°C. Uni or bilateral antegrade cerebral perfusion according to runoff. Four devices were used: a straight tube, a tube with 3 or 4 branches, and a frozen elephant trunk. 37 patients were operated on; 24 of them were men. The average age was 57 years old. In seven patients, a straight tube with anastomosis was used with anastomosis on the island; in six patients, a tube with 3 branches; in ten patients, a tube with four branches; and in fourteen patients, a frozen elephant trunk. There were twenty-one patients (57%) with associated morbidity: prolonged mechanical ventilation 14 the most frequent, paralysis chordae in 7 patients; there were six neurological morbidities, one of them permanent, renal dysfunction in 5 patients, pneumonia associated with mechanical ventilation in 4 patients, reoperation due to bleeding in 4. There was no associated cardiac morbidity. Operative and global mortality at 30 days was 13.5%. Follow-up was closed in October 2022 and is complete in the 30 survivors; the average was 20 months. Two patients died in the follow-up at five years; the survival in the follow-up was 90%. The management protocol has good results regarding morbidity and mortality, similar to the international series.