Advanced Search

Home > Journals > The Journal of Cardiovascular Surgery > Past Issues > The Journal of Cardiovascular Surgery 2015 August;56(4) > The Journal of Cardiovascular Surgery 2015 August;56(4):531-46

ISSUES AND ARTICLES   MOST READ   eTOC

CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Frequency: Bi-Monthly

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 2015 August;56(4):531-46

AORTIC ARCH LESIONS AND DISSECTIONS 

Aortic arch repair today: open repair is best for most arch lesions

Coselli J. S. 1, 2, Green S. Y. 3

1 Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Baylor St. Luke’s Medical Center, Houston, TX, USA;
2 Section of Adult Cardiac Surgery, Baylor College of Medicine, Baylor St. Luke’s Medical Center, Houston, TX, USA;
3 Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

The transverse aortic arch is challenging to repair by either evolving open or emerging endovascular approaches. Contemporary experience in aortic arch repair can be difficult to assess because clinical practice varies substantially among centers with regard to temperature targets for hypothermic circulatory arrest, temperature monitoring sites, circulating perfusate temperatures, cerebral perfusion monitoring techniques, perfusion catheter flow rates, cannulation sites, pH management, and protective pharmacologic agents. Repair of the aortic arch has changed substantially over the last decade; these changes appear to have substantially reduced patient risk. In general, contemporary outcomes of open aortic arch repair are good to excellent. When acute aortic dissection is absent, many centers report early mortality rates below 5%; when acute aortic dissection is present, these rates are doubled or tripled. Not unexpectedly, mortality rates for total transverse aortic arch repair with elephant trunk or frozen elephant trunk approaches are greater than those for hemiarch repair (7-17% vs. 3-4%). In contemporary reports of mixed hemiarch and total arch repairs for aortic aneurysm, several authors report early mortality rates and stroke rates below 5%. Surprisingly, mortality rates for reoperation are not unlike those for primary repair and range from 8% to 9%; however, the risk of stroke appears somewhat greater and ranges from 5% to 6%.

language: English


FULL TEXT  REPRINTS

top of page