Non-circulatory arrest aortic arch replacement

Abstract

The definitive management of combined aortic arch and descending aortic pathologies such as aneurysms and dissections is either a single or staged operation associated with high morbidity and mortality. Stroke, kidney dysfunction, coagulopathy and high blood transfusion requirements are all affiliated with hypothermic circulatory arrest and prolonged cardiopulmonary bypass times. Considering the perilous nature of these operations, the authors describe a step-by-step zone 2 arch replacement as a staged frozen elephant trunk procedure, which provides an adequate landing zone for a later-placed endovascular stent yet maintains a short cardiopulmonary bypass time and no circulatory arrest.

Keywords: Aneurysm repair; Aorta; Aortic aneurysm; Aortic arch; Aortic arch branched graft; Aortic arch repair; Aortic arch replacement; Aortic dissection; Aortic surgery; Cannulation techniques; Cerebral protection; Descending aorta; Endovascular aortic repair; Frozen elephant trunk technique; Hypothermia; Thoracic aortic aneurysm; Thoracic endovascular aneurysm repair.