The Cervical Branch-First Technique in complex resternotomy
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0329
Submission Type:
Abstract Submission
Authors:
Michelle Ng (1), George Matalanis (1)
Institutions:
(1) Austin Health, Victoria, Australia
Submitting Author:
Michelle Ng
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Austin Health
Austin Health
Co-Author:
George Matalanis
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Austin Health
Austin Health
Presenting Author:
Michelle Ng
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Abstract:
Objective: Branch-first total aortic arch repair (BF-TAR) has been a paradigm shift in the technical approach to open aortic surgery. This technique is further modified to instigate hostile sternal re-entry in reoperative aortic surgery whilst assuring uninterrupted neuroprotection.
Methods: Intraoperative preparation and the illustrated operative technique of the cervical branch-first technique in complex resternotomy are described. An accompanying case series narrates the experiences and outcomes of four complex patients who underwent high-risk reoperative aortic surgery utilising this technique.
Results: The indications for resternotomy included (1) a sixth reoperation for recurrent mycotic aortic pseudoaneurysm; (2) a third reoperation for extensive infective endocarditis; (3) a reoperation for complete Bentall graft dehiscence with contained ascending aortic rupture; and (4) a third reoperation for residual Stanford Type B dissection. All patients had evidence of significant adhesion between the aorta, aortic graft, and/or pseudoaneurysm to the posterior sternal stable. Two patients were operated on in an emergency setting. Two patients separated from cardiopulmonary bypass with extracorporeal support. None experienced permanent neurological sequelae, gut ischaemia, peripheral arterial complications, or in-hospital mortality. One mortality due to decompensated heart failure was reported at six months postoperatively.
Conclusions: The cervical branch-first technique offers unparallel advantage in neuroprotection from an early stage of complex reoperative aortic surgery. It provides an independent circuit for complete antegrade cerebral perfusion, irrespective of suspension to circulatory flows to the rest of the body during re-entry into hostile chests. Our experience to date has demonstrated promising outcomes and further refinements will guide patient selection best suited for this technique.
Methods: Intraoperative preparation and the illustrated operative technique of the cervical branch-first technique in complex resternotomy are described. An accompanying case series narrates the experiences and outcomes of four complex patients who underwent high-risk reoperative aortic surgery utilising this technique.
Results: The indications for resternotomy included (1) a sixth reoperation for recurrent mycotic aortic pseudoaneurysm; (2) a third reoperation for extensive infective endocarditis; (3) a reoperation for complete Bentall graft dehiscence with contained ascending aortic rupture; and (4) a third reoperation for residual Stanford Type B dissection. All patients had evidence of significant adhesion between the aorta, aortic graft, and/or pseudoaneurysm to the posterior sternal stable. Two patients were operated on in an emergency setting. Two patients separated from cardiopulmonary bypass with extracorporeal support. None experienced permanent neurological sequelae, gut ischaemia, peripheral arterial complications, or in-hospital mortality. One mortality due to decompensated heart failure was reported at six months postoperatively.
Conclusions: The cervical branch-first technique offers unparallel advantage in neuroprotection from an early stage of complex reoperative aortic surgery. It provides an independent circuit for complete antegrade cerebral perfusion, irrespective of suspension to circulatory flows to the rest of the body during re-entry into hostile chests. Our experience to date has demonstrated promising outcomes and further refinements will guide patient selection best suited for this technique.
Aortic Symposium:
Cerebral Protection
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