When is it possible to perform aortic arch repair according to hemi-arch technique without circulatory arrest?

• Vachev A.N.
• Dmitriev O.V.
• Kozin I.I.
• Chernovalov D.A.
• Italiantsev A.Yu.
• Gryaznova D.A.
• Kutsenko V.V.

Abstract

Described herein is a technique of aortic hemi-arch repair without circulatory arrest in the variant “warm head-warm body”. Discussed in detail is a situation when it is possible to manage with unilateral cerebral perfusion and in what cases it is necessary to switch to bihemispheric perfusion.

Also presented is the world experience in aortic arch repair without circulatory arrest according to the PubMed database, suggesting that the main disputable technical problems of performing such operations include the technique and place of blocking retrograde blood flow from the distal portion of the aorta.

A conclusion was made that the absence of pathological changes in the distal portion of the aortic arch and technical possibility of applying a clamp distal to the left subclavian artery are the conditions for prosthetic repair of the aortic arch according to the hemi-arch technique without circulatory arrest. If it is necessary to expand the scope of intervention, such technique does not prevent switching to operation with circulatory arrest.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Vachev A.N., Dmitriev O.V., Kozin I.I., Chernovalov D.A., Italiantsev A.Yu., Gryaznova D.A., Kutsenko V.V. When is it possible to perform aortic arch repair according to hemi-arch technique without circulatory arrest? Angiology and Vascular Surgery. 2022; 28 (1): 64–71. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-64-71 (in Russian)

Keywords:aortic arch aneurysm; aortic arch prosthetic repair without circulatory arrest; hemi-arch; circulatory arrest; antegrade cerebral perfusion

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