Simplified Arch-first Technique in Aortic Arch Branches Replacement:
Perfusion without Cardiopulmonary Bypass
Abstract
Abstract Introduction:Surgery is the mainstay of
treatment for aortic dissection which lesion affected the aortic arch.
Conventional surgical methods usually use unilateral cerebral perfusion
by cardiopulmonary bypass (CPB) to maintain the perfusion of the brain,
and the reconstruction of arch branches must be performed under CPB.
Unilateral cerebral perfusion with prolonged CPB may lead to
complications of cerebral hypoperfusion. We propose a new technique that
can accomplish aortic arch branches replacement without the use of
cardiopulmonary bypass and maintain bilateral cerebral perfusion at all
times. Materials and Methods: From January 2018 to July 2021,
we performed the new technique in 23 patients. Furthermore, we performed
a retrospective analysis with patients undergoing conventional surgery
during the same period, comparing perioperative data and follow-up data
between two groups. Result: The CPB time, deep hypothermic
circulatory arrest time and aortic cross-clamping time of new technique
group was significantly shorter than conventional group. Other
perioperative data and follow-up data were not statistically different.
Discussion: Simplified arch-first technique can significantly
shorten CPB, aortic cross-clamping and deep hypothermic circulatory
arrest time. The technique is theoretically safer because it can better
protect the cerebral perfusion during the operation. The short-term
efficacy of this technique is the same as that of conventional surgery,
and it is more convenient for surgeons to operate. Conclusions:
Compared with the conventional method, the simplified arch-first
technique is non-inferior, friendly in operation and safer in theory,
and is worthy of promotion. Key words: Aortic dissection;
Arch-first; Cardiopulmonary bypass; Aortic arch reconstruction