Open repair techniques in the aortic arch are still superior

Bachet, Jean

doi:10.21037/acs.2018.05.05

Cited by 22 publications

(10 citation statements)

References 67 publications

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“…The reported advantages conferred by HAR include reduced rates of cardiopulmonary bypass and circulatory arrest and shortened lengths of intensive care unit and hospital stay, while the rates of aortic events and reinterventions are high after HAR in comparison with OAR. 2 , 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

Late Retrograde Aortic Dissection after Hybrid Thoracic Endovascular Aortic Repair (TEVAR): A Case Report

Boroumand¹,

Ahmadi-Tafti²,

Davoodi³

et al. 2021

JTHC

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Open total arch replacement is allied to high rates of mortality and morbidity; surgeons, therefore, tend to choose hybrid aortic arch repair as a less invasive operative procedure for the treatment of aortic arch aneurysms, especially in high-risk patients. However, studies on the early and late outcomes of patients undergoing hybrid aortic arch repair have revealed high rates of reintervention and reoperation compared with open total arch replacement. Here, we describe a male patient with late retrograde aortic dissection after hybrid thoracic endovascular aortic repair for aortic arch aneurysms. The patient returned 3 years after the procedure with signs of dyspnea on exertion and chest pain. Transthoracic echocardiography and computed tomography showed dissection of the ascending aorta, for which he underwent a redo Bentall procedure. The patient was weaned from cardiopulmonary bypass without any problem and discharged after 7 days.

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Section: Discussionmentioning

confidence: 99%

Late Retrograde Aortic Dissection after Hybrid Thoracic Endovascular Aortic Repair (TEVAR): A Case Report

Boroumand¹,

Ahmadi-Tafti²,

Davoodi³

et al. 2021

JTHC

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“…Покращенню візуалізації судин дуги аорти сприяє продовження шкірного розрізу в напрямку до лівого кивального м'яза. Для зручності маніпуляцій на гілках дуги рекомендують пересікати ліву брахіоцефальну (плече-головну) вену, яку потім навіть не обов'язково відновлювати [3]. Виділяти гілки дуги і підводити тасьми доцільно, якщо це доступно і безпечно.…”

Section: український журнал серцево-судинної хірургії 2020 3 (40)unclassified

“…Протилежної думки дотримується Bachet J. -визнаний експерт у цій галузі, який, не заперечуючи перспективності гібридного підходу, вважає «відкриту» операцію кращою за ендопротезування [3].…”

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Total Aortic Arch Replacement: Indications and Technical Considerations of Surgical Management

Kulyk

Protsyk

Beshley

et al. 2020

ujcvs

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The total aortic arch replacement is one of the most technically demanding operations, the main risk of which is the intraoperative ischemic lesion of the brain. Despite progress, operating mortality associated with this operation, even at the most renowned specialized centers reaches 7.3%. An alternative to the classic “open” operation is aortic endoprosthesis, combined with the procedure of debranching. This approach allows diminishing trauma by reducing the duration of the cardiopulmonary bypass. The aim. To describe the rational approach for replacing the total aortic arch depending on the diameter of aneurysm, the condition of the arch vessels, and the acuteness of clinical condition.The main indications for the replacement of the aortic arch are the true atherosclerotic aneurysms, genetic connective tissue diseases (Marfan syndrome), syphilis. The total arch replacement recently becomes more frequent indication for acute type A aortic dissection. The newly introduced strategies of operation and perfusion for total aortic arch replacement are aimed to reduce the risk of neurological complications. This method is named “arch first technique” which gradually replaces the earlier technique, at which the first anastomosis is performed with a descending thoracic aorta. A more traditional method called the “descending aorta first” was selected. A mandatory element of both types of the operation is antegrade cerebral perfusion. The main advantage of this method is maintaining constant perfusion of the brain which significantly reduces the risk of its ischemic damage, avoids deep hypothermia and its negative impact on blood coagulation system. The technique of total arch replacement consists of the following elements: access, double arterial cannulation, the method of brain protection, formation of distal anastomosis with descending thoracic aorta, implantation of arch vessels into the prosthesis. Sequence of anastomosis depends on morphological and clinical peculiarities of the specific case. Changes in the strategy for “open” total aortic arch replacement in various aortic pathologies is discussed based on the author’s clinical experience and literature data. Conclusions. Total aortic arch replacement remains a traumatic and technically demanding operation, the main risks of which are hemorrhage and ischemic brain lesions. The method of arch replacement – “descending aorta first” includes double arterial cannulation, antegrade cerebral perfusion, deep hypothermia with complete blood flow stoppage for the lower half of the body and the use of multi-branch vascular prosthesis.

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“…Classic conventional aortic arch replacement is currently being offered to the majority of patients, but hybrid and endovascular techniques have gained popularity. These less invasive approaches can often be as technically challenging as open surgery with stroke and endo-leaks as early limiting factors and less favourable mid-to long-term results [3]. At the present time, reported mid-term outcomes and intra-operative complication rates with both hybrid and conventional aortic arch surgery remain heterogeneous and depend on centre experience and patient suitability [4].…”

Section: Introductionmentioning

confidence: 99%

“…When central aortic cannulation is not feasible, arterial cannulation through one of the femoral arteries (either directly or via an end-to-side Dacron graft) is appropriate. Axillary artery cannulation [5] is gaining interest, but it is not without other risks and complications [3,6]. The innominate [7] and the common carotid artery [8] have also been considered as cannulation sites.…”

Section: Introductionmentioning

confidence: 99%

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

Capoccia

Nienaber

Mireskandari

et al. 2021

JCDD

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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.

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Open repair techniques in the aortic arch are still superior

Cited by 22 publications

References 67 publications

Late Retrograde Aortic Dissection after Hybrid Thoracic Endovascular Aortic Repair (TEVAR): A Case Report

Late Retrograde Aortic Dissection after Hybrid Thoracic Endovascular Aortic Repair (TEVAR): A Case Report

Total Aortic Arch Replacement: Indications and Technical Considerations of Surgical Management

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

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