Alternative Approach for Cerebral Protection during Complex Aortic Arch and Redo Surgery
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 op...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-07-01
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| Series: | Journal of Cardiovascular Development and Disease |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2308-3425/8/8/86 |
| _version_ | 1797523461801771008 |
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| author | Massimo Capoccia Christoph A. Nienaber Maziar Mireskandari Michael Sabetai Christopher Young Nicholas J. Cheshire Ulrich P. Rosendahl |
| author_facet | Massimo Capoccia Christoph A. Nienaber Maziar Mireskandari Michael Sabetai Christopher Young Nicholas J. Cheshire Ulrich P. Rosendahl |
| author_sort | Massimo Capoccia |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-10T08:43:18Z |
| format | Article |
| id | doaj.art-c855da80b4ef4add8675490cb640a4d4 |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-10T08:43:18Z |
| publishDate | 2021-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-c855da80b4ef4add8675490cb640a4d42023-11-22T08:08:13ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252021-07-01888610.3390/jcdd8080086Alternative Approach for Cerebral Protection during Complex Aortic Arch and Redo SurgeryMassimo Capoccia0Christoph A. Nienaber1Maziar Mireskandari2Michael Sabetai3Christopher Young4Nicholas J. Cheshire5Ulrich P. Rosendahl6Aortic Centre, Royal Brompton Hospital, London SW3 6NP, UKAortic Centre, Royal Brompton Hospital, London SW3 6NP, UKAortic Centre, Royal Brompton Hospital, London SW3 6NP, UKCardiac Surgery, Guy’s & St. Thomas’ Hospital, London SE1 9RS, UKCardiac Surgery, Guy’s & St. Thomas’ Hospital, London SE1 9RS, UKAortic Centre, Royal Brompton Hospital, London SW3 6NP, UKAortic Centre, Royal Brompton Hospital, London SW3 6NP, UKTotal 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.https://www.mdpi.com/2308-3425/8/8/86arch surgerycerebral protectionredo surgery |
| spellingShingle | Massimo Capoccia Christoph A. Nienaber Maziar Mireskandari Michael Sabetai Christopher Young Nicholas J. Cheshire Ulrich P. Rosendahl Alternative Approach for Cerebral Protection during Complex Aortic Arch and Redo Surgery Journal of Cardiovascular Development and Disease arch surgery cerebral protection redo surgery |
| title | Alternative Approach for Cerebral Protection during Complex Aortic Arch and Redo Surgery |
| title_full | Alternative Approach for Cerebral Protection during Complex Aortic Arch and Redo Surgery |
| title_fullStr | Alternative Approach for Cerebral Protection during Complex Aortic Arch and Redo Surgery |
| title_full_unstemmed | Alternative Approach for Cerebral Protection during Complex Aortic Arch and Redo Surgery |
| title_short | Alternative Approach for Cerebral Protection during Complex Aortic Arch and Redo Surgery |
| title_sort | alternative approach for cerebral protection during complex aortic arch and redo surgery |
| topic | arch surgery cerebral protection redo surgery |
| url | https://www.mdpi.com/2308-3425/8/8/86 |
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