Total surgical aortic arch replacement as a safe strategy to treat complex multisegmental proximal thoracic aortic pathology
| Autor: | Thierry Carrel, Florian S. Schoenhoff, Hansjörg Jenni, Maximilian Rieger, Tobias König, Reto Basciani, Martin Czerny, Jürg Schmidli, Gottfried Sodeck, David Reineke |
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| Rok vydání: | 2013 |
| Předmět: |
Pulmonary and Respiratory Medicine
Aortic dissection Aortic arch medicine.medical_specialty Pathology Aorta Elephant trunks business.industry Perioperative medicine.disease Surgery Aneurysm Interquartile range Anesthesia medicine.artery Medicine Thoracic aorta Cardiology and Cardiovascular Medicine business |
| Zdroj: | Interactive CardioVascular and Thoracic Surgery. 17:532-536 |
| ISSN: | 1569-9285 1569-9293 |
| DOI: | 10.1093/icvts/ivt260 |
| Popis: | OBJECTIVE To analyse the results after elective open total aortic arch replacement. METHODS We analysed 39 patients (median age 63 years, median logistic EuroSCORE 18.4) who underwent elective open total arch replacement between 2005 and 2012. RESULTS In-hospital mortality was 5.1% (n = 2) and perioperative neurological injury was 12.8% (n = 5). The indication for surgery was degenerative aneurysmal disease in 59% (n = 23) and late aneurysmal formation following previous surgery of type A aortic dissection in 35.9% (n = 14); 5.1% (n = 2) were due to anastomotical aneurysms after prior ascending repair. Fifty-nine percent (n = 23) of the patients had already undergone previous proximal thoracic aortic surgery. In 30.8% (n = 12) of them, a conventional elephant trunk was added to total arch replacement, in 28.2% (n = 11), root replacement was additionally performed. Median hypothermic circulatory arrest time was 42 min (21-54 min). Selective antegrade cerebral perfusion was used in 95% (n = 37) of patients. Median follow-up was 11 months [interquartile range (IQR) 1-20 months]. There was no late death and no need for reoperation during this period. CONCLUSIONS Open total aortic arch replacement shows very satisfying results. The number of patients undergoing total arch replacement as a redo procedure and as a part of a complex multisegmental aortic pathology is high. Future strategies will have to emphasize neurological protection in extensive simultaneous replacement of the aortic arch and adjacent segments. |
| Databáze: | OpenAIRE |
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