Long-term outcome after aortic arch replacement with a trifurcated graft

Abstract

Aortic arch replacement using a trifurcated graft is highly durable, with excellent patency in the branch grafts, and is associated with a low incidence of cerebral embolization. However, the long-term outcome in these patients is compromised by extensive comorbidities.

Aortic arch replacement without circulatory arrest or deep hypothermia: The “branch-first” technique

“…With adequate care and planning, most of these technical issues can be eliminated. 26 Care is still required to handle the aorta with a ''no touch'' technique to avoid the risks of embolic events from an atheromatous arch.…”

Evolving Knowledge About Age and Hypothermic Circulatory Arrest in Aortic Surgery

“…Commercially available trifurcated prostheses facilitate surgical aortic arch repair with excellent long-term durability. 4 Reinstallation of cardiopulmonary bypass via a sidearm of the prosthesis ensures a more physiological body perfusion, which is an important issue in aortic dissections. Besides the advances in the surgical technique, anesthesiological management improved substantially.…”

Evolution in the Techniques and Outcomes of Aortic Arch Surgery: A 22 Year Single Centre Experience

“…Deep hypothermic circulatory arrest (DHCA) was introduced and shown to be effective in prooperations to replace the aortic arch and is seen by many surgeons as 'best practice' [3,4,[12][13][14][15][16].…”

“…Initially three branched, then after 1993 four branched to allow for a perfusion lumen [19]. Others, especially Spielvogel and colleagues, have advocated using trifurcated grafts, believing that it leads to less manipulation of the head and neck vessels, reduced circulatory arrest time to the brain and at least as satisfactory results in regards to morbidity and mortality compared to standard ACP [13,14,[20][21][22]. The 'Elephant Trunk' technique, introduced by Borst et al has been used to allow the distal anastomosis to be completed more proximally where there is greater vision and access as well providing a proximal attachment point for open or, increasingly, endovascular second stage operations for descending thoracic aortic lesions [23].…”

“…Earlier series reported mortality rates of 42% in the 1960s [2] to 23-28% in the 1980s-90s [24,25]. However mortality rates in modern large series have been in the range of 6-16% [3,13] and permanent neurological morbidity has been in the range of 3-9% [4,26]. Our unit's techniques have evolved over time, utilising most of the techniques mentioned, hence we decided to review our outcomes.…”