"Open" approach to aortic arch aneurysm repair

Adil H. Al Kindi, Nasser Al Kimyani, Tarek Alameddine, Qasim Al Abri, Baskaran Balan, Hilal Al Sabti

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

Aortic arch aneurysm is a relatively rare entity in cardiac surgery. Repair of such aneurysms, either in isolation or combined with other cardiac procedures, remains a challenging task. The need to produce a relatively bloodless surgical field with circulatory arrest, while at the same time protecting the brain, is the hallmark of this challenge. However, a clear understanding of the topic allows a better and less morbid approach to such a complex surgery. Literature has shown the advantage of selective cerebral perfusion techniques in comparison with only circulatory arrest. Ability to perfuse the brain has allowed circulatory arrest temperatures at moderate hypothermia without the need for deep hypothermia. Even though cannulation site selection appears to be a minor issue, literature has shown that the subclavian/axillary route has the best outcomes and that femoral cannulation should only be reserved for no access patients. Although different techniques for arch anastomosis have been described, we routinely perform the distal first technique as we find it to be less cumbersome and easiest to reproduce. In this review our aim is to outline a systematic approach to aortic arch surgery. Starting with indications for intervention and proceeding with approaches on site of cannulation, approaches to brain protection with hypothermia and selective cerebral perfusion and finally surgical steps in performing the distal and arch vessels anastomosis.

Original languageEnglish
Pages (from-to)152-161
Number of pages10
JournalJournal of the Saudi Heart Association
Volume26
Issue number3
DOIs
Publication statusPublished - 2014

Fingerprint

Aortic Aneurysm
Hypothermia
Thoracic Aorta
Catheterization
Brain
Perfusion
Thigh
Thoracic Surgery
Aneurysm
Temperature

Keywords

  • Aortic arch aneurysm
  • Distal first anastomosis
  • Hypothermic circulatory arrest
  • Open repair
  • Selective cerebral perfusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

"Open" approach to aortic arch aneurysm repair. / Al Kindi, Adil H.; Al Kimyani, Nasser; Alameddine, Tarek; Al Abri, Qasim; Balan, Baskaran; Al Sabti, Hilal.

In: Journal of the Saudi Heart Association, Vol. 26, No. 3, 2014, p. 152-161.

Research output: Contribution to journalReview article

Al Kindi, Adil H. ; Al Kimyani, Nasser ; Alameddine, Tarek ; Al Abri, Qasim ; Balan, Baskaran ; Al Sabti, Hilal. / "Open" approach to aortic arch aneurysm repair. In: Journal of the Saudi Heart Association. 2014 ; Vol. 26, No. 3. pp. 152-161.
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