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Current Status and Future Challenges of Aortic Arch Surgery
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Current Status and Future Challenges of Aortic Arch Surgery

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Cardiac Surgery".

Deadline for manuscript submissions: 31 July 2025 | Viewed by 4441

Special Issue Editors

Dr. Jason Ali

E-Mail Website
Guest Editor
Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge CB2 0AY, UK
Interests: minimal-access cardiac surgery; risk scoring; EuroSCORE; postoperative outcomes; heart and lung transplantation
Special Issues, Collections and Topics in MDPI journals
Dr. Ravi De Silva

E-Mail Website
Guest Editor
Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge CB2 0AY, UK
Interests: aortic surgery; aortic valve repair; minimally invasive cardiac surgery; total arterial revascularization

Special Issue Information

Dear Colleagues,

Aortic arch surgery is technically challenging and requires true multidisciplinary collaboration at all stages. In preparation for elective aortic arch surgery there is careful planning, requiring input from radiologists, vascular surgeons, cardiothoracic surgeons, perfusionists and anaesthetists. Intraoperatively, this collaboration is even more important, particularly during periods of circulatory arrest, requiring careful management of cerebral and spinal cord perfusion.

With aortic arch replacement being performed at high-volume specialist centres, outcomes have become very good. Advances in techniques such as the use of composite grafts with frozen elephant trunks have also contributed to improved outcomes being observed, but also facilitate the management of descending thoracic aortic pathology.

It is also important to acknowledge that advances in stent technology are continuing, with the prospect of aortic arch stenting starting to become a reality in selected cases, again requiring multidisciplinary input and planning.

In this Special Issue, we hope to explore the state of the art in aortic arch surgery, both elective and emergency, considering the patient pathway and exploring the multidisciplinary considerations that contribute to the excellent outcomes observed.

Dr. Jason Ali
Dr. Ravi De Silva
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • aortic arch
  • aneurysm
  • aortic dissection
  • frozen elephant trunk
  • TEVAR
  • acute aortic syndrome
  • deep hypothermic circulatory arrest
  • cerebral perfusion
  • spinal cord protection

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Published Papers (5 papers)

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Research

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15 pages, 2927 KiB  
Article
Changes in Abdominal Artery Diameter in Patients Treated for Acute Aortic Dissection
by Marian Burysz, Radosław Litwinowicz, Mariusz Kowalewski, Jerzy Walocha and Jakub Batko
J. Cardiovasc. Dev. Dis. 2025, 12(4), 129; https://doi.org/10.3390/jcdd12040129 - 2 Apr 2025
Viewed by 240
Abstract
Background: Mesenteric ischemia significantly increases intraoperative mortality in patients with acute aortic dissection (AAD). The arterial diameter affects both blood flow and arterial resistance. There are no data in the literature on changes in arterial diameter in patients with AAD. It has already [...] Read more.
Background: Mesenteric ischemia significantly increases intraoperative mortality in patients with acute aortic dissection (AAD). The arterial diameter affects both blood flow and arterial resistance. There are no data in the literature on changes in arterial diameter in patients with AAD. It has already been demonstrated that changes in arterial diameter can be observed in patients with non-occlusive intestinal ischemia. The aim of this study was to compare the arterial branches of the abdominal aorta in patients with AAD preoperatively and postoperatively. Methods: Preoperative and postoperative contrast-enhanced computed tomography scans of 25 patients who had undergone the frozen elephant trunk procedure for the treatment of AAD were reconstructed and retrospectively analyzed with detailed medical data of the patients. Results: In patients without AAD at the level of the abdominal aorta, statistically significant differences were observed when comparing the diameter of the superior mesenteric artery (p < 0.001) and the renal arteries (p < 0.001) between preoperative and postoperative scans. Occlusion of the inferior mesenteric artery was more common in patients with AAD involving the abdominal aorta. Statistically significant differences in true and false lumen were observed at each level of the abdominal aorta after a successful frozen elephant trunk procedure. Conclusion: Significant changes in visceral artery diameter were observed at the abdominal aortic level in patients both with and without aortic dissection. Chronic or non-occlusive mesenteric ischemia may be associated with a lack of adjustment in arterial diameter. Patients with AAD of the abdominal aorta are more susceptible to occlusion of the inferior mesenteric artery. Full article
(This article belongs to the Special Issue Current Status and Future Challenges of Aortic Arch Surgery)
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9 pages, 803 KiB  
Article
Aortic Aneurysm with and without Dissection and Concomitant Atherosclerosis—Differences in a Retrospective Study
by Andrey V. Suslov, Tatiana V. Kirichenko, Andrey V. Omelchenko, Petr V. Chumachenko, Alexandra Ivanova, Yury Zharikov, Yuliya V. Markina, Alexander M. Markin and Anton Yu. Postnov
J. Cardiovasc. Dev. Dis. 2024, 11(10), 311; https://doi.org/10.3390/jcdd11100311 - 8 Oct 2024
Viewed by 969
Abstract
Background: Thoracic aortic aneurysm is a latent disease with a high risk of death. Today, as data are accumulating, an estimation of the differences in thoracic aneurysm in men and women of different age groups is required. The present study evaluated the type [...] Read more.
Background: Thoracic aortic aneurysm is a latent disease with a high risk of death. Today, as data are accumulating, an estimation of the differences in thoracic aneurysm in men and women of different age groups is required. The present study evaluated the type of atherosclerotic aortic lesions in males and females at different ages regarding the presence or absence of aortic dissection. Methods: A retrospective analysis of clinical and morphological data of 43 patients with thoracic aortic aneurysm was carried out. Patients were divided into groups based on the presence or absence of thoracic aneurysm dissection. Results: Our results of a comparative analysis of the age of study participants showed that patients with aneurysm dissection were younger than patients without dissection. In the subgroup of patients with aortic dissection, the mean age was 50.6 years old, and in patients without aortic dissection, the mean age was 55.0 years old. When conducting a frequency analysis using Fisher’s exact test, it was found that in men and women aneurysm dissection was not associated with atherosclerotic lesions of the aorta. Conclusions: In women and men, aneurysm dissection was not associated with stage of atherosclerotic lesions of the aorta regardless of age; no statistically significant differences were found between the groups with and without aneurysm dissection (p > 0.05). Dissection of the thoracic aneurysm developed in the absence of severe atherosclerosis of the thoracic aorta. Only 18.6% men and women possessed atherosclerotic plaques of types IV and V. Full article
(This article belongs to the Special Issue Current Status and Future Challenges of Aortic Arch Surgery)
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Review

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11 pages, 569 KiB  
Review
Cerebral and Spinal Cord Protection Strategies in Aortic Arch Surgery
by Andrea Myers, Ciprian Nita and Guillermo Martinez
J. Cardiovasc. Dev. Dis. 2025, 12(4), 130; https://doi.org/10.3390/jcdd12040130 - 2 Apr 2025
Viewed by 267
Abstract
Perioperative management of patients undergoing surgeries of the aortic arch is challenging. This cohort of patients has a high risk of poor neurological outcomes both as a consequence of the disease process as well as the methods employed during surgical management. Many strategies [...] Read more.
Perioperative management of patients undergoing surgeries of the aortic arch is challenging. This cohort of patients has a high risk of poor neurological outcomes both as a consequence of the disease process as well as the methods employed during surgical management. Many strategies have been put forward to ameliorate these complications; however, maintaining cerebral and spinal cord perfusion and reducing metabolic oxygen demand is the core principle of these strategies. Moderate hypothermia and selective ante-grade perfusion are the most promising methods that provide the best conditions for the competing requirements of both the brain and spinal cord. Intraoperative and postoperative monitoring is essential for early detection and intervention in delayed spinal cord ischaemia and stroke. In this article we aim to discuss the current methods of neuroprotection and spinal cord protection in aortic arch surgery and stenting. Full article
(This article belongs to the Special Issue Current Status and Future Challenges of Aortic Arch Surgery)
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12 pages, 1406 KiB  
Review
The Management of the Aortic Arch in Type A Aortic Dissection: Replace, Repair with the AMDS, or Leave for Another Day?
by Ryaan EL-Andari and Michael C. Moon
J. Cardiovasc. Dev. Dis. 2025, 12(1), 23; https://doi.org/10.3390/jcdd12010023 - 12 Jan 2025
Viewed by 1127
Abstract
Objectives: Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires emergent surgical intervention. Numerous surgical approaches exist for ATAAD, and controversy remains regarding the optimal arch interventions for ATAAD patients. Aortic Arch Interventions: Approaches to ATAAD repair include hemiarch repair [...] Read more.
Objectives: Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires emergent surgical intervention. Numerous surgical approaches exist for ATAAD, and controversy remains regarding the optimal arch interventions for ATAAD patients. Aortic Arch Interventions: Approaches to ATAAD repair include hemiarch repair or extended arch repairs, including the hemiarch with a hybrid stent implantation, such as the AMDS hybrid Prosthesis, total arch replacement (TAR), and the use of an elephant trunk and frozen elephant trunk. While indications for each procedure exist, such as entry tears in the arch, arch aneurysms, and head vessel communications for TAR and malperfusion and a reduced risk of distal anastomotic new entry tears in Debakey I aortic dissection for the AMDS and frozen elephant trunks, the optimal intervention depends on numerous factors. Surgeon and center experience, resource availability, patient risk, and anatomy all contribute to the decision-making process. TAR has improved in safety over the years and has been demonstrated to be comparable to the hemiarch repair in terms of safety in many settings. TAR may also prevent adverse remodeling and can effectively treat more distal diseases, the presence of arch tears, arch aneurysms, and branch vessel involvement or malperfusion. Conclusions: Numerous surgical approaches exist to manage ATAAD, allowing for the surgeon to tailor the repair to the individual patient and pathology. TAR allows for single or staged repair of extensive pathologies and can address distal entry tears, the aneurysmal arch, and head vessel pathologies. In cases with malperfusion, an AMDS can be used in many cases. The management strategy for ATAAD should always involve performing the best surgery for the patient, although in cases where a total arch is indicated but cannot be performed safely by a non-aortic surgeon, the safest approach may be to perform a hemiarch initially and to plan for an elective arch reoperation in the case it is required following close surveillance. Full article
(This article belongs to the Special Issue Current Status and Future Challenges of Aortic Arch Surgery)
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10 pages, 810 KiB  
Review
Management of Non-A Non-B Aortic Dissection: A Narrative Review
by Joseph Kletzer, Stoyan Kondov, Aleksandar Dimov, Victoria Werdecker, Martin Czerny, Maximilian Kreibich and Tim Berger
J. Cardiovasc. Dev. Dis. 2025, 12(1), 1; https://doi.org/10.3390/jcdd12010001 - 24 Dec 2024
Viewed by 1166
Abstract
Non-A non-B aortic dissection remains a complex and controversial topic in cardiovascular management, eliciting varied approaches among cardiologists and surgeons. Due to the limited evidence surrounding this condition, existing guidelines are limited in the complexity of their recommendations. While most patients are initially [...] Read more.
Non-A non-B aortic dissection remains a complex and controversial topic in cardiovascular management, eliciting varied approaches among cardiologists and surgeons. Due to the limited evidence surrounding this condition, existing guidelines are limited in the complexity of their recommendations. While most patients are initially managed medically, invasive treatment becomes necessary in a large proportion of patients. When surgery is considered, the most utilized techniques include the frozen elephant trunk procedure and endovascular repair strategies targeting the arch and descending thoracic aorta. This narrative review aims to synthesize current knowledge and clinical experiences, highlighting the challenges and evolving practices related to non-A non-B dissection management. Full article
(This article belongs to the Special Issue Current Status and Future Challenges of Aortic Arch Surgery)
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