Transverse Aortic Arch Aneurysm

TLDR

Graft replacement for aneurysms of the entire transverse aortic arch has historically yielded poorer outcomes, with a 25 % mortality versus 8 % for thoracoabdominal aneurysms, largely because of limitations in cerebral and myocardial protection methods. The study aims to evaluate profound hypothermia combined with graft inclusion and direct brachiocephalic arterial reattachment to protect the brain and prevent operative bleeding. The cohort included eight patients with extensive thoracic aortic disease, involving the entire aorta in four, the valve in two, coronary bypass in two, and pulmonary artery obstruction in one. Previous high mortality was attributed to inadequate bypass and perfusion techniques, but applying the described hypothermic and reattachment strategy resulted in all eight patients surviving without complications.

Abstract

The results of graft replacement for aneurysms involving the entire transverse aortic arch have lagged far behind that achieved for similar lesions located elsewhere. For example, prior to the study reported here, the mortality rate of the former, in our experience, was 25%, whereas it was only 8% for the most extensive forms of thoracoabdominal aortic aneurysms. The difference has been due to limitations and complications of methods employed for cerebral and myocardial protection. The high mortality rate in our patients was due to the deficiencies of temporary bypass graft and cardiopulmonary bypass, and separate brachiocephalic perfusion employed for this purpose. This report is concerned with the use of profound hypothermia for cerebral protection and the application of graft inclusion and direct brachiocephalic arterial reattachment to prevent bleeding in region of operation, as so successfully employed in patients with thoracoabdominal aortic aneurysms. The entire thoracic aorta was involved in four patients, the aortic valve in two patients, coronary artery bypass was performed in two patients, and the pulmonary artery was obstructed in one patient. Employing the techniques described in this report, all eight patients with these extensive lesions survived without complication