Operative Techniques

Aortic arch surgery is a complex and difficult operation to perform. Surgical techniques have evolved significantly over the past few years, with increasingly better patient outcomes and survival.

The Annals of Cardiothoracic Surgery has published two highly detailed and interesting issues with regards to traditional aortic arch surgery and hybrid aortic arch surgery.

Below are several detailed ‘How I Do It’ articles from leading arch surgeons.

Sun’s procedure for complex aortic arch repair: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation

This illustrated article from Ma and colleagues at the Beijing Aortic Disease Center details the Sun procedure – total arch replacement using a tetrafurcated graft with a frozen elephant trunk. The technical essentials of Sun’s procedure include implantation of the special open stented graft into the descending aorta, total arch replacement with…

Open fenestration for complicated acute aortic B dissection

This illustrated article from Trimarchi and colleagues at the Policlinico San Donato IRCCS details open fenestration for complicated acute type B dissection. The aim of the open fenestration is to resolve the malperfusion by creating a single aortic lumen at the suprarenal or infrarenal level. This surgical procedure is less invasive than…

Emergent treatment of aortic rupture in acute type B dissection

This illustrated article from Trimarchi and colleagues at the Policlinico San Donato IRCCS describes the emergent treatment of aortic rupture in the setting of acute type B dissection. In these patients, thoracic endovascular repair (TEVAR) is the most frequent management, although its planning, in these emergent patients, may be very difficult and…

Total aortic arch replacement: current approach using the trifurcated graft technique

This illustrated article from LeMaire and colleagues at the Texas Heart Institute describes total aortic arch replacement in patients with aneurysms that are confined to the ascending aorta and transverse aortic arch. The operation uses innominate artery cannulation, deep-to-moderate hypothermic circulatory arrest with antegrade cerebral perfusion, bilateral cerebral monitoring with near-infrared spectroscopy,…

Surgical techniques of total arch replacement using selective antegrade cerebral perfusion

This detailed illustrated article by Okita and colleagues describes their preferred surgical technique of total arch replacement using selective antegrade cerebral perfusion (SACP). Theapproach includes: (I) meticulous selection of arterial cannulation site and type of arterial cannula; (II) SACP for neuro-protection; (III) whole body hypothermia with minimal tympanic temperatures between…

IAASG: ARCH Projects | International Aortic Arch Surgery Study Group