Change of paradigm in the aortic arch reconstruction – “warm head – cool body”

Abstract

<p><strong>Aim.</strong> The article focuses on the immediate outcomes of a new technology implemented in total reconstruction of the aortic arch and its branches. <br /><strong>Methods.</strong> From January 2014 to July 2016 56 patients underwent aortic arch reconstruction by the proposed new technology. The age was from 23 till 73 years (median 57,5). Indications for aortic arch reconstruction were an aneurysm of the aortic arch (32 patients, 57 %), acute (8 patients, 14 %) and DeBakey Types 1 and 2 chronic dissection (16 patients, 29 %). The proposed technology of aortic arch reconstruction included four interrelated components: 1) total individual antegrade cerebral perfusion in the normothermic mode; 2) a system of two independent circuits of perfusion; 3) original method of prosthetic aortic arch branches in reverse order (“Opposite Branch First Technique”); 4) Penza aortic cannulation technique (“Penza Cannulation”).<br /><strong>Results.</strong> No in-hospital mortality was observed. There were two cases of neurological deficit in the immediate postoperative period, associated with atrial fibrillation. CPB time was 177.5 (92-312) minutes. The time of ASCP was 145 (78-220) min. Intraoperative blood loss was 626.5 (300-3200) ml. Patients were extubated 8.9 (3.6-106.8) hours after surgery and held 3 (2-23) days in ICU.<br /><strong>Conclusion.</strong> The proposed technology of aortic arch reconstruction is a radical, universal and individual method. It shows good clinical results without in-hospital mortality. This method allows for using the technique of “open distal anastomosis” simultaneously with normothermic cerebral perfusion.<br /><strong>Keywords:</strong> aortic aneurysm; aortic dissection; total reconstruction of the aortic arch; selective antegrade cerebral perfusion; normothermic perfusion</p><p>Received 26 October 2016. Accepted 14 December 2016.</p><p><strong>Funding:</strong> The study had no sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.<br /><strong>Author contributions</strong><br />Conceptualization and study design: Rosseykin E.V., Evdokimov M.E., Bazylev V.V.<br />Material acquisition and analysis: Evdokimov M.E., Batrakov P.A., Gebgart T.V.<br />Statistical data processing: Evdokimov M.E., Batrakov P.A., Kobzev E.E.<br />Article writing: Evdokimov M.E., Batrakov P.A. <br />Review &amp; editing: Evdokimov M.E., Rosseykin E.V., Bazylev V.V.</p>