Partial/Total Arch Replacement

According to the last European Guidelines surgery should be considered in patients who have isolated aortic arch aneurysm with maximal diameter 55 mm or more. Aortic arch repair may be considered even in patients with aortic arch aneurysm who already have an indication for surgery of an adjacent aneurysm located in the ascending or descending aorta.

The partial or total Arch replacement is permormed without cross-clamping the Aorta (open procedure). The surgical treatment of the aortic arch aneurysm consists in excising the aneurysm and replace it with a prosthetic tube graft. The aortic arch replacement can be partial or total. The supra-aortic vessels involved are sutured to the graft with a single arterial button or separately, using a branched graft. Hypotermic circulatory arrest with moderate hypotermia (26 Celsius degrees) should be established with mono or bilateral cerebral perfusion, during the distal anastomosis time of the branched graft. Continuous monitoring of cerebral oxygenation and perfusion is required during this phase. The surgical approach is performed with a traditional full median sternotomy.