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Aortic arch surgery: what I would have done different? The Kobe/Takatsuki experience

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Our current approach towards total arch replacement includes the following: (1) innominate vein mobilization, (2) no neck vessel taping, and no dissection of the vagal nerve, (3) meticulous selection of arterial cannulation site and type of arterial cannula, (4) antegrade cerebral perfusion(ACP)for neuro-protection, utilizing three balloon-tipped cannular from inside the arch, (5) whole-body hypothermia with minimal tympanic temperatures between 20 and 23 °C and minimal rectal temperatures below 30 °C, (6) distal enucleation and felt reinforcement for in zone III distal anastomosis using four branched graft, (7) early re-warming after distal anastomosis with ACP flow adjustment while monitoring brain oxygenation by near-infrared spectroscopy (NIRS) and (8) second anastomosis is proximal and last one is arch vessel reconstruction, (9) maintaining strict fluid balance below 1000 ml by the extracorporeal ultrafiltration method (ECUM) during cardiopulmonary bypass (CPB), with the expectation of more rapid pulmonary functional recovery.

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Authors and Affiliations

  1. Cardio-Aortic Center, Takatsuki General Hospital, Kosobe 1-3-13, TakatsukiTakatsuki, Osaka, 569-1192, Japan

    Yutaka Okita

  2. Kobe University, Kobe, Japan

    Yutaka Okita

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  1. Yutaka Okita
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Correspondence to Yutaka Okita.

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This project was approved by the Institutional Review Board, and the requirement for informed consent was waived. This study was approved as was in accordance with the ethical standards of the IRB and with the Helsinki Declaration.

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Okita, Y. Aortic arch surgery: what I would have done different? The Kobe/Takatsuki experience. Indian J Thorac Cardiovasc Surg 38 (Suppl 1), 50–57 (2022). https://doi.org/10.1007/s12055-021-01254-6

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  • DOI: https://doi.org/10.1007/s12055-021-01254-6

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