Rare types of aortic arch aneurysms

The study focuses on modern approaches to diagnostics and surgical treatment of patients with aneurysms of the thoracic aorta combined with congenital pathologies of the aortic arch and brachiocephalic arteries. The effect of hypothermia, extracorporeal blood circulation, cerebral perfusion, preventive transposition of the aberrant subclavian arteries is evaluated in the context of prevention of postoperative complications. 34 patients with aneurysms of the thoracic aorta were included in the study. Aortic aneurysms were found in 22 of patients with congenital aortic arch defects and in 12 patients with an abnormal position of the arch and/or brachiocephalic arteries. Aberrant origin of the subclavian arteries is the most common defect of the arch in the case of thoracic aorta aneurysms. Aortic arch kinking and congenital anomalies of the aortic arch significantly influence the tactic of surgical treatment of aneurysms because of a high probability of clamping the aortic arch branches and neurological complications. Therefore, prevention of cerebral complications is the primary objective of surgery. Cerebral perfusion or staged surgical interventions also find extensive use. A congenital aortic arch in a number of patients determines a surgical approach and influences the choice of techniques. Surgical treatment of aortic aneurysms associated with congenital anomalies or kinking of the aortic arch depends on a set of several factors. The surgical decision must be based on precise preoperative diagnosis and detailed analysis of all individual anatomical characteristics of the aortic arch and its branches. The safety and efficacy of operations can only be achieved on the basis of a differentiated and individual approach.Received 6 October 2016. Accepted 11 December 2016.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest.Author contributions All authors meet ICMJE authorship criteria and contributed equally at all stages of the research.

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Surgical treatment of the ascending aorta and aortic arch with antegrade cerebral perfusion and moderate hypothermia]]>

Brazilian Journal of Cardiovascular Surgery ◽

10.1590/s1678-97412006000400017 ◽

2006 ◽

Vol 21 (4) ◽

Author(s):

Marcelo S. S. Martins ◽

Mauro P. L. S� ◽

Leonardo Abad ◽

Eduardo S. Bastos ◽

Ney Franklin Junior ◽

...

Keyword(s):

Surgical Treatment ◽

Aortic Arch ◽

Cerebral Perfusion ◽

Ascending Aorta ◽

Moderate Hypothermia ◽

Antegrade Cerebral Perfusion

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Intraoperative video showing the sequence of the operation highlighting the removal of the stent and infected material and further reconstruction of the aortic arch, proximal descending thoracic aorta and supra-aortic trunks using a Thoraflex PlexusTM (Terumo Aortic, Vascutek) with cardiopulmonary bypass, moderate hypothermic circulatory arrest and antegrade cerebral perfusion.

ASVIDE ◽

10.21037/asvide.2021.367 ◽

2021 ◽

Vol 8 ◽

pp. 367-367

Author(s):

Ana Lopez-Marco ◽

Saleem Jahangeer ◽

Benjamin Adams ◽

Aung Ye Oo

Keyword(s):

Cardiopulmonary Bypass ◽

Aortic Arch ◽

Thoracic Aorta ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Descending Thoracic Aorta ◽

Infected Material ◽

Antegrade Cerebral Perfusion

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Surgical Treatment of the Distal Aortic Arch Aneurysm Using Selective Cerebral Perfusion

Cardio-aortic and Aortic Surgery ◽

10.1007/978-4-431-65934-1_21 ◽

2001 ◽

pp. 134-141

Author(s):

Koichi Tabayashi ◽

Mikio Ohmi ◽

Atsushi Iguchi ◽

Hitoshi Yokoyama ◽

Hiroji Akimoto ◽

...

Keyword(s):

Surgical Treatment ◽

Aortic Arch ◽

Cerebral Perfusion ◽

Aortic Arch Aneurysm ◽

Selective Cerebral Perfusion ◽

Distal Aortic Arch Aneurysm ◽

Arch Aneurysm

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Selective Cerebral Perfusion in Patients with Aortic Aneurysms Involving the Aortic Arch

ASAIO Journal ◽

10.1097/00002480-199339030-00010 ◽

1993 ◽

Vol 39 (3) ◽

pp. M202-M203 ◽

Cited By ~ 1

Author(s):

Hideto Shinpo ◽

Chiaki Kondo ◽

Takatugu Shimono ◽

Kuniyoshi Tnanaka ◽

Isao Yada ◽

...

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Aortic Aneurysms ◽

Selective Cerebral Perfusion

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Clinical evaluation of surgical treatment of thoracic aortic aneurysms involving the aortic arch under deep hypothermic circulatory arrest

Cardiovascular Surgery ◽

10.1016/0967-2109(95)94333-r ◽

1995 ◽

Vol 3 ◽

pp. 128-128

Author(s):

D SEGAWA ◽

H YOSHIZU ◽

N HATORI ◽

Y URIUDA ◽

Y HAGA ◽

...

Keyword(s):

Surgical Treatment ◽

Aortic Arch ◽

Clinical Evaluation ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Aortic Aneurysms ◽

Thoracic Aortic Aneurysms

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Aortic Arch Aneurysm. Compression Respiratory Complications as a Vital Indication for Emergency Surgery.

10.21203/rs.3.rs-145199/v1 ◽

2021 ◽

Author(s):

Husam H. Balkhy ◽

Roman Komarov ◽

Vladimir Parshin ◽

Alisher Ismailbayev ◽

Nikolay Kurasov ◽

...

Keyword(s):

Respiratory Failure ◽

Aortic Arch ◽

Thoracic Aorta ◽

Emergency Surgery ◽

Giant Aneurysm ◽

Community Acquired Pneumonia ◽

Pulmonary Complications ◽

Ascending Aorta ◽

Aortic Aneurysms ◽

Risk Of Rupture

Abstract Background: giant thoracic aortic aneurysms and aortic arch dissections are accompanied by high mortality rates, cardiac and neurologic events and pulmonary complications. Aorta-tracheal fistula and tracheobronchial compression are formidable and well-known complications of aneurysms of the thoracic aorta. Twenty-two percent of aneurysms that size >6 cm are ruptured with 80% mortality rate.Case presentation: a 56-year-old man with severe multivascular coronary artery injury and giant aneurysm of ascending aorta and aortic arch, complicated by respiratory failure and recurrent community-acquired pneumonia. Preoperative chest CT showed giant partially-thrombosed ampullary false aneurysm of ascending aorta, aortic arch and initial part of the thoracic aorta, 80x100x65 mm in size. Patient successfully underwent simultaneous surgical intervention with artificial blood circulation, the total time of cardiopulmonary bypass was 190 minutes.Conclusions: tracheobronchial compression syndrome with the aortic arch aneurysms is one of the urgent conditions that needs emergency surgery. Urgent indications for surgery in such cases include both significant size of the aneurysm and high risk of rupture, as well as potential for developing critical respiratory failure and recurrent nonresolving pneumonias. Preoperative CT enables to find out the exact location and evaluate the degree of airway compression, which determines further intraoperative actions. We recommend to use bronchoscopy at all steps of treatment of such patients, from intubation in operating room to extubation in intensive care unit. Thus, aggressive surgical tactics along with careful pre-operative diagnostic are the key to success and the only chance for such patients.

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Study on cerebral damage observed at surgical treatment of aortic arch aneurysms using extracorporeal circulation with selective cerebral perfusion.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.20.262 ◽

1990 ◽

Vol 20 (2) ◽

pp. 262-264

Author(s):

J. Kondo

Keyword(s):

Surgical Treatment ◽

Aortic Arch ◽

Extracorporeal Circulation ◽

Cerebral Perfusion ◽

Cerebral Damage ◽

Selective Cerebral Perfusion

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SELECTIVE CEREBRAL PERFUSION WITH COLD BLOOD FOR THE SURGICAL TREATMENT OF AORTIC ARCH ANEURYSM

ASAIO Journal ◽

10.1097/00002480-199604000-00142 ◽

1996 ◽

Vol 42 (2) ◽

pp. 39

Author(s):

A. Yamaquchi ◽

H. Adachi ◽

N. Momose ◽

T. Ino

Keyword(s):

Surgical Treatment ◽

Aortic Arch ◽

Cerebral Perfusion ◽

Aortic Arch Aneurysm ◽

Selective Cerebral Perfusion ◽

Cold Blood ◽

Arch Aneurysm

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Cerebral and visceral organ protection during aortic arch surgery. Intraoperative tactics and monitoring details

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2016-4-34-44 ◽

2016 ◽

Vol 20 (4) ◽

pp. 34 ◽

Cited By ~ 9

Author(s):

Yu. V. Belov ◽

E. R. Charchyan ◽

B. A. Akselyrod ◽

D. A. Gusykov ◽

S. V. Fedulova ◽

...

Keyword(s):

Aortic Arch ◽

Core Temperature ◽

Conflict Of Interest ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Organ Protection ◽

Aortic Arch Surgery ◽

Aortic Replacement ◽

Ascending Aortic Replacement ◽

Antegrade Cerebral Perfusion

Aim. The study is aimed at presenting the protocol of intraoperative organ protection, analyzing its effectiveness during aortic arch surgery and evaluating the rate of postoperative complications in this group of patients. Methods. The study included 141 patients. In the first group (n=70) patients underwent aortic arch surgery with hypothermic circulatory arrest (target core temperature 26 °C) and antegrade cerebral perfusion. Patients of the second group (n=71) underwent ascending aortic replacement using cardiopulmonary bypass with moderate hypothermia (target core temperature 32 °C). Cerebral and tissue oxygenation monitoring was performed in all the cases. In the first group transcranial Doppler monitoring was also performed. 33 patients in the first group and 34 patients in the second group underwent testing before and after surgery in order to evaluate cognitive function. Patients’ condition was evaluated during the in-hospital period that was about 15.97±20.54 days. Results. In-hospital mortality rate was 4,2 % in the first group and 0% in the second one (p=0.12). Stroke was observed in 1.4 and 0 % of cases respectively. The rate of encephalopathy (as the leading symptom) was 7.1 and 5.6 % in 1st and 2nd groups respectively. Multimodal monitoring enabled to dynamically adjust the flow rate of antegrade cerebral perfusion. As a result, cerebral SctO2 and linear velocity were maintained within the acceptable range. Conclusion. The presented protocol proved to be effective, it allows to perform aortic arch surgery with the same postoperative neurological complications’ rate as after ascending aortic replacement. We recommend performing reconstructive aortic arch surgery by using moderate hypothermic circulatory arrest (26-28 °С) and selective antegrade cerebral perfusion. In this modality, it is important to perform the distal anastomosis quickly and start patient’s rewarming (this will significantly shorten the duration of cardiopulmonary bypass and, as a result, decrease the rate of postoperative complications) and to carry out both precise intraoperative monitoring of the brain condition (by using cerebral oxymetry and transcranial Doppler) and central core temperature.Received 21 June 2016. Accepted 21 October 2016.Funding: The study had no sponsorship. Conflict of interest: The authors declare no conflict of interest. Author contributions Conceptualization and study design: Belov Yu.V., Charchyan E.R., Akselrod B.A. Material acquisition and analysis: Khachatryan Z.R., Oystrakh A.S., Medvedeva L.A., Guskov D.A., Fedulova S.V. Statistical data processing: Khachatryan Z.R., Guskov D.A., Skvortsov A.A. Article writing: Akselrod B.A., Khachatryan Z.R., Skvortsov A.A. Review & editing: Charchyan E.R., Akselrod B.A., Eremenko A.A., Belov Yu.V.

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