Multiple Cardiac Diseases Involving the Aortic Arch: Beating Heart Debranching, and Normothermic Arch Replacement: A Case Series
(1) <b>Background</b>: Conventional open surgery is still the gold standard for aortic arch disease, and despite recent developments in optimizing strategies for neuroprotection, distal organ perfusion, and myocardial protection, aortic arch replacement is still associated with high morb...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/3/732 |
| _version_ | 1797318633229123584 |
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| author | Alessandro Motta Cristian Scarpari Ermelinda Borrelli Francesco Formica |
| author_facet | Alessandro Motta Cristian Scarpari Ermelinda Borrelli Francesco Formica |
| author_sort | Alessandro Motta |
| collection | DOAJ |
| description | (1) <b>Background</b>: Conventional open surgery is still the gold standard for aortic arch disease, and despite recent developments in optimizing strategies for neuroprotection, distal organ perfusion, and myocardial protection, aortic arch replacement is still associated with high morbidity and mortality rates. (2) <b>Methods</b>: We present our case series of 12 patients undergoing surgical management of multiple cardiac diseases involving the aortic arch. In this single-center study, we report our initial experience over a five-year period (from December 2018 to October 2023) with the use of a “debranching first” technique for the supra-aortic vessels of a beating heart, followed by the cardiac step addressing proximal diseases, and a final distal step treating the aortic arch. This strategy aims to minimize cardiac, cerebral, and peripheral ischemia. (3) <b>Results</b>: Six patients underwent aortic root replacement with either Bentall (<i>n</i> = 4) or valve-sparing aortic root (David procedure) (<i>n</i> = 2). The mean nasopharyngeal temperature was 34 °C and the mean cardiocirculatory arrest was 14.3 min. The early mortality was 8.3% (1 patient); no patient experienced a permanent neurologic event. (4) <b>Conclusions</b>: In patients with complex aortic disease and concomitant cardiac disease, this approach reduces the need for hypothermia and decreases cardiopulmonary bypass time and myocardial arrest time and therefore could represent a valid surgical option, even in high-risk patients. |
| first_indexed | 2024-03-08T03:55:10Z |
| format | Article |
| id | doaj.art-f4b5e3b110fe413bb609a298644c52c2 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-08T03:55:10Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-f4b5e3b110fe413bb609a298644c52c22024-02-09T15:15:46ZengMDPI AGJournal of Clinical Medicine2077-03832024-01-0113373210.3390/jcm13030732Multiple Cardiac Diseases Involving the Aortic Arch: Beating Heart Debranching, and Normothermic Arch Replacement: A Case SeriesAlessandro Motta0Cristian Scarpari1Ermelinda Borrelli2Francesco Formica3UO Cardiochirurgia, APSS—Ospedale Santa Chiara, Largo Medaglie d’Oro, 38100 Trento, ItalyUO Cardiochirurgia, APSS—Ospedale Santa Chiara, Largo Medaglie d’Oro, 38100 Trento, ItalyUO Cardiochirurgia, APSS—Ospedale Santa Chiara, Largo Medaglie d’Oro, 38100 Trento, ItalyUO Cardiochirurgia, APSS—Ospedale Santa Chiara, Largo Medaglie d’Oro, 38100 Trento, Italy(1) <b>Background</b>: Conventional open surgery is still the gold standard for aortic arch disease, and despite recent developments in optimizing strategies for neuroprotection, distal organ perfusion, and myocardial protection, aortic arch replacement is still associated with high morbidity and mortality rates. (2) <b>Methods</b>: We present our case series of 12 patients undergoing surgical management of multiple cardiac diseases involving the aortic arch. In this single-center study, we report our initial experience over a five-year period (from December 2018 to October 2023) with the use of a “debranching first” technique for the supra-aortic vessels of a beating heart, followed by the cardiac step addressing proximal diseases, and a final distal step treating the aortic arch. This strategy aims to minimize cardiac, cerebral, and peripheral ischemia. (3) <b>Results</b>: Six patients underwent aortic root replacement with either Bentall (<i>n</i> = 4) or valve-sparing aortic root (David procedure) (<i>n</i> = 2). The mean nasopharyngeal temperature was 34 °C and the mean cardiocirculatory arrest was 14.3 min. The early mortality was 8.3% (1 patient); no patient experienced a permanent neurologic event. (4) <b>Conclusions</b>: In patients with complex aortic disease and concomitant cardiac disease, this approach reduces the need for hypothermia and decreases cardiopulmonary bypass time and myocardial arrest time and therefore could represent a valid surgical option, even in high-risk patients.https://www.mdpi.com/2077-0383/13/3/732aortic arch replacementfrozen elephant trunkdebranchingcerebral perfusion |
| spellingShingle | Alessandro Motta Cristian Scarpari Ermelinda Borrelli Francesco Formica Multiple Cardiac Diseases Involving the Aortic Arch: Beating Heart Debranching, and Normothermic Arch Replacement: A Case Series Journal of Clinical Medicine aortic arch replacement frozen elephant trunk debranching cerebral perfusion |
| title | Multiple Cardiac Diseases Involving the Aortic Arch: Beating Heart Debranching, and Normothermic Arch Replacement: A Case Series |
| title_full | Multiple Cardiac Diseases Involving the Aortic Arch: Beating Heart Debranching, and Normothermic Arch Replacement: A Case Series |
| title_fullStr | Multiple Cardiac Diseases Involving the Aortic Arch: Beating Heart Debranching, and Normothermic Arch Replacement: A Case Series |
| title_full_unstemmed | Multiple Cardiac Diseases Involving the Aortic Arch: Beating Heart Debranching, and Normothermic Arch Replacement: A Case Series |
| title_short | Multiple Cardiac Diseases Involving the Aortic Arch: Beating Heart Debranching, and Normothermic Arch Replacement: A Case Series |
| title_sort | multiple cardiac diseases involving the aortic arch beating heart debranching and normothermic arch replacement a case series |
| topic | aortic arch replacement frozen elephant trunk debranching cerebral perfusion |
| url | https://www.mdpi.com/2077-0383/13/3/732 |
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