Aortic arch surgery: methods and clinical experience (Report of 75 cases) / 中华胸心血管外科杂志

ABSTRACT

Objective To summarize the methods and experiences of aortic arch surgery. Methods In 75 aortic arch operations, 74 were performed by using deep hypothermic circulatory arrest (DHCA), including retrograde cerebral perfusion (RCP) in 54 cases and antegrade selective cerebral perfusion (SCP) in 20 cases. Surgical procedures included ascending aortic and hemiarch grafting in 53 cases, which concomitantly included stent placement intra decending aorta in 11, patching of arch intimal tear in 6 and of decending aortic one in 3. Ascending and total arch grafting in 20 cases,which concomitantly included traditional elephant trunk procedure in 12 and stent placement intra decending aorta in 4. Simple arch aneurysm resection in 1 and arch grafting in 1. Concomitant procedures included Bentall procedure in 17 cases, AVR in 12, Cabrol procedure in 3, mitral valvuloplasty in 5 and aortic valvuloplasty in 9. DHCA time ranged from 9 to 120 min (mean 42.3 min). Results Operative mortality was 6.7%. The most common complications were respiratory insufficiency(11 cases), renal insufficience(7 cases) and temporary mental anomaly(9 cases). Conclusion DHCA+RCP and DHCA+SCP are both effective while the latter is more suitable for complex aortic arch surgery. The choice of surgical procedures depends on the nature of lesion and location of intimal tear. Preoperative condition and surgical technique are the essential factors to success in aortic arch surgery.