Partial Clamping of the Brachiocephalic Trunk for Total Ascending Aorta Replacement without Circulatory Arrest: Early and Midterm Results
Background: The aim of this study was to evaluate in elective patients the early and midterm results of partial clamping of the brachiocephalic trunk (BCT) for total ascending aorta replacement (TAAR) without circulatory arrest. Contraindications to the procedure were BCT/aortic arch calcifications and chronic aortic dissection.
Methods: The right radial artery was cannulated to monitor the systemic pressure after the BCT was partially clamped. A specially designed clamp was applied obliquely to occlude approximately 50% of the BCT and part of the aortic arch. The distal tip of the clamp was positioned in front of the left subclavian artery. From January 2002 to October 2003, 92 patients underwent TAAR. In 62 patients (67.4%), partial clamping of the BCT was used. Twenty of these patients underwent isolated TAAR, 27 underwent aortic valve replacement and TAAR, 11 had a Bentall operation, and 2 had a Cabrol operation. The aortic valve was spared in the remaining 2 patients. The mean ( ± SD) aortic cross-clamping and cardiopulmonary bypass times were 96 ± 31 minutes and 116 ± 43 minutes, respectively. Results: Early mortality was 1.6% (1 patient). No cerebrovascular accidents occurred, demonstrating the safety of the technique. The major complications were acute respiratory insufficiency in 2 cases and acute renal failure in 5. The mean follow-up time was 9.0 ± 6.5 months. The mean 18-month and event-free survival rate was 96.6% ± 0.9%. Conclusion: Partial clamping of the BCT for TAAR without circulatory arrest provides good early and midterm clinical results. Aortic arch clamping is not associated with cerebrovascular accidents.
McCullough JN, Zhang N, Reich D, et al. 1999. Cerebral metabolic suppression during circulatory arrest in humans. Ann Thorac Surg 67:1895-9.nScorsin M, Al-Attar N, Scarci M, et al. 2003. Total ascending aorta replacement without circulatory arrest. J Thorac Cardiovasc Surg 125:126-8.nSvensson LJ, Crawford ES, Hess KR, et al. 1993. Deep hypothermia with circulatory arrest. J Thorac Cardiovasc Surg 106:19-31.nWestaby S. 1997. Coagulation disturbances in profound hypothermia. Semin Thorac Cardiovasc Surg 9:246-56.nCalafiore AM. 2003. Brachiocephalic trunk partial clamping for total ascending aorta replacement without circulatory arrest. Ann Thorac Surg 2003;75:1337.nDi Eusanio M, Schepens MA, Morshuis WJ, Di Bartolomeo R, Pierangeli A, Dossche KM. 2002. Antegrade selective cerebral perfusion during operations on the thoracic aorta: factors influencing survival and neurologic outcome in 413 patients. J Thorac Cardiovasc Surg 124:1080-86.nDossche KM, Schepens MA, Morshuis WJ, Muysoms FE, Langemeijer JJ, Vermeulen FE. 1999. Antegrade selective cerebral perfusion in operations on the proximal thoracic aorta. Ann Thorac Surg 67:1904-10.nErgin MA, Galla JD, Lansman SL, Quintana C, Bodian C, Griepp RB. 1994. Hypothermic circulatory arrest in operations on the thoracic aorta: determinants of operative mortality and neurologic outcome. J Thorac Cardiovasc Surg 107:788-97.nGottlieb RA, Burleson KO, Kloner RA, Babior BM, Engler RL. 1994. Reperfusion injury induces apoptosis in rabbit cardio-myocytes. J Clin Invest 94:1621-8.nGriepp RB. 2001. Cerebral protection during aortic arch surgery. J Thorac Cardiovasc Surg 121:425-7.nHagl C, Ergin MA, Galla JD, et al. 2001. Neurologic outcome after ascending aorta-aortic arch operations: effect of brain protection technique in high-risk patients. J Thorac Cardiovasc Surg 121:1107-21.nKazui T, Kimura N, Yamada O, Komatsu S. 1994. Surgical outcome of aortic arch aneurysm using selective antegrade perfusion. Ann Thorac Surg 57:904-11.nLangley SM, Chai PJ, Tsui SS, Jaggers JJ, Ungerleider RM. 2000. The effects of a leukocyte-depleting filter on cerebral and renal recovery after deep hypothermic circulatory arrest. J Thorac Cardiovasc Surg 119:1262-9.n
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