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Transversal Arch Clamping for Complete Resection of Aneurysms of the Distal Ascending Aorta without Open Anastomosis

Background: The extent of aortic replacement for aneurysms of the distal ascending aorta remains controversial and opinions vary between standard cross-clamp resection and open hemiarch anastomosis in circulatory arrest and selective cerebral perfusion. As the deleterious effects of extended circula...

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Autores principales: Rukosujew, Andreas, Motekallemi, Arash, Wisniewski, Konrad, Weber, Raluca, De Torres-Alba, Fernando, Ibrahim, Abdulhakim, Weiss, Raphael, Martens, Sven, Dell’Aquila, Angelo Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9144450/
https://www.ncbi.nlm.nih.gov/pubmed/35628825
http://dx.doi.org/10.3390/jcm11102698
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author Rukosujew, Andreas
Motekallemi, Arash
Wisniewski, Konrad
Weber, Raluca
De Torres-Alba, Fernando
Ibrahim, Abdulhakim
Weiss, Raphael
Martens, Sven
Dell’Aquila, Angelo Maria
author_facet Rukosujew, Andreas
Motekallemi, Arash
Wisniewski, Konrad
Weber, Raluca
De Torres-Alba, Fernando
Ibrahim, Abdulhakim
Weiss, Raphael
Martens, Sven
Dell’Aquila, Angelo Maria
author_sort Rukosujew, Andreas
collection PubMed
description Background: The extent of aortic replacement for aneurysms of the distal ascending aorta remains controversial and opinions vary between standard cross-clamp resection and open hemiarch anastomosis in circulatory arrest and selective cerebral perfusion. As the deleterious effects of extended circulatory arrest are well-known, borderline indication for distal ascending aorta aneurysm repair must be outweighed against the potential risk of complications related to the open anastomosis. In the present study, we describe our own approach consisting of “transversal arch clamping” for exhaustive resection of aneurysms of the distal ascending aorta without open anastomosis and we present the postoperative outcomes. Methods: Between May 2017 and December 2019, 35 patients with aneurysm of the ascending aorta (20 male, 15 female) underwent replacement with repair of the lesser curvature without circulatory arrest. Pre-operative, intraoperative, and postoperative clinical outcomes were retrospectively withdrawn from our institutional database and analyzed. Results: Maximal diameter of distal ascending aorta was 47.5 mm. Patient median age was 66 years (IQR 14) (range 42–86). Preoperative logistic median EuroSCORE II was 17% (IQR 11.3). Median duration of cardiopulmonary bypass and cardiac arrest were 137 (IQR 64) and 93 (IQR 59) min, respectively. In-hospital and 30-day mortality were 0%. There were no cases with acute low output syndrome, surgical re-exploration for bleeding, kidney injury requiring dialysis, or wound infection. Disabling stroke was observed in one patient (2.9%). There was one case of major ventricular arrhythmia (2.9%). Conclusions: Our institutional experience suggests that this novel technique is safe and feasible. It facilitates complete resection of the aortic ascending aneurysm avoiding circulatory arrest, antegrade cerebral perfusion, additional peripheral cannulation, and all related complications.
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spelling pubmed-91444502022-05-29 Transversal Arch Clamping for Complete Resection of Aneurysms of the Distal Ascending Aorta without Open Anastomosis Rukosujew, Andreas Motekallemi, Arash Wisniewski, Konrad Weber, Raluca De Torres-Alba, Fernando Ibrahim, Abdulhakim Weiss, Raphael Martens, Sven Dell’Aquila, Angelo Maria J Clin Med Article Background: The extent of aortic replacement for aneurysms of the distal ascending aorta remains controversial and opinions vary between standard cross-clamp resection and open hemiarch anastomosis in circulatory arrest and selective cerebral perfusion. As the deleterious effects of extended circulatory arrest are well-known, borderline indication for distal ascending aorta aneurysm repair must be outweighed against the potential risk of complications related to the open anastomosis. In the present study, we describe our own approach consisting of “transversal arch clamping” for exhaustive resection of aneurysms of the distal ascending aorta without open anastomosis and we present the postoperative outcomes. Methods: Between May 2017 and December 2019, 35 patients with aneurysm of the ascending aorta (20 male, 15 female) underwent replacement with repair of the lesser curvature without circulatory arrest. Pre-operative, intraoperative, and postoperative clinical outcomes were retrospectively withdrawn from our institutional database and analyzed. Results: Maximal diameter of distal ascending aorta was 47.5 mm. Patient median age was 66 years (IQR 14) (range 42–86). Preoperative logistic median EuroSCORE II was 17% (IQR 11.3). Median duration of cardiopulmonary bypass and cardiac arrest were 137 (IQR 64) and 93 (IQR 59) min, respectively. In-hospital and 30-day mortality were 0%. There were no cases with acute low output syndrome, surgical re-exploration for bleeding, kidney injury requiring dialysis, or wound infection. Disabling stroke was observed in one patient (2.9%). There was one case of major ventricular arrhythmia (2.9%). Conclusions: Our institutional experience suggests that this novel technique is safe and feasible. It facilitates complete resection of the aortic ascending aneurysm avoiding circulatory arrest, antegrade cerebral perfusion, additional peripheral cannulation, and all related complications. MDPI 2022-05-10 /pmc/articles/PMC9144450/ /pubmed/35628825 http://dx.doi.org/10.3390/jcm11102698 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Rukosujew, Andreas
Motekallemi, Arash
Wisniewski, Konrad
Weber, Raluca
De Torres-Alba, Fernando
Ibrahim, Abdulhakim
Weiss, Raphael
Martens, Sven
Dell’Aquila, Angelo Maria
Transversal Arch Clamping for Complete Resection of Aneurysms of the Distal Ascending Aorta without Open Anastomosis
title Transversal Arch Clamping for Complete Resection of Aneurysms of the Distal Ascending Aorta without Open Anastomosis
title_full Transversal Arch Clamping for Complete Resection of Aneurysms of the Distal Ascending Aorta without Open Anastomosis
title_fullStr Transversal Arch Clamping for Complete Resection of Aneurysms of the Distal Ascending Aorta without Open Anastomosis
title_full_unstemmed Transversal Arch Clamping for Complete Resection of Aneurysms of the Distal Ascending Aorta without Open Anastomosis
title_short Transversal Arch Clamping for Complete Resection of Aneurysms of the Distal Ascending Aorta without Open Anastomosis
title_sort transversal arch clamping for complete resection of aneurysms of the distal ascending aorta without open anastomosis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9144450/
https://www.ncbi.nlm.nih.gov/pubmed/35628825
http://dx.doi.org/10.3390/jcm11102698
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