Open AccessArticle
A Less Invasive Approach to Repair the Aortic Arch Using a “Partial or Complete Debranching” of the Supraaortic Vessels
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Jürg Schmidli, Dai-Do Do, Jürgen Triller, Iris Baumgartner, Pascal Berdat, Fritz Widmer, Felix Mahler and Thierry Carrel
Cardiovasc. Med. 2005, 8(3), 82; https://doi.org/10.4414/cvm.2005.01083 (registering DOI) - 30 Mar 2005
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Abstract
Surgical replacement of the aortic arch is an established procedure that requires cardiopulmonary bypass and deep hypothermic circulatory arrest. However, this approach is associated with major perioperative risks. These risks and the fact that thoracic aneurysms have become more ubiquitous are the main
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Surgical replacement of the aortic arch is an established procedure that requires cardiopulmonary bypass and deep hypothermic circulatory arrest. However, this approach is associated with major perioperative risks. These risks and the fact that thoracic aneurysms have become more ubiquitous are the main argument for less invasive strategies. To treat complex coarctation (recurrence, hypoplastic aortic arch), various surgical approaches have been proposed. In these cases, resection with end-to-end anastomosis may be demanding and expose the patient to a substantial morbidity. Cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest may be necessary to control the distal aortic arch. We present a less invasive, combined surgical and endovascular approach that allows partial or total exclusion of the aortic arch without the need for extracorporeal circulation, deep hypothermia and circulatory arrest. This technique was applied to 7 patients over the last 22 years. All procedures were technically successful and 6 of 7 patients recovered well. Arteriography confirmed proper position of the stent graft and complete exclusion of the lesion at the end of the procedure. One patient had an endoleak type I and underwent successful additional retrograde stent-graft placement over the proximal landing zone three weeks following the initial procedure. One patient had a diffuse cerebral and spinal damage, most probably due to embolic shower during the procedure. Clinical follow-up (between 8 and 18 months) has been fully uncomplicated in the 6 other patients and CT-scan at 6 months demonstrated complete exclusion of the arch lesion. Assuming that technical refinements may improve the steps of the endovascular intervention, this combined approach may turn out to be the preferred therapeutic modality to repair aortic arch lesions in patients with multiple co-morbidities who otherwise would not be candidates for a conventional operative repair. Long-term observation is necessary to confirm the stability of this type of repair.
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