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J Thorac Cardiovasc Surg 2003;125:126-128
© 2003 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Total replacement of the ascending aorta without circulatory arrest

Marcio Scorsin, MDa, Nawwar Al-Attar, MDa, Marco Scarci, MDb, Michele Di Mauro, MDb, Richard Raffaul, MDa, Arrigo Lessana, MDa, Antonio Maria Calafiore, MDb

From the Departments of Cardiac Surgerya and Cardiology,b G. D'Annunzio University, Chieti, Italy.

Received for publication April 17, 2002. Revisions requested June 12, 2002; revisions received July 8, 2002. Accepted for publication July 12, 2002. Address for reprints: Antonio Maria Calafiore, MD, G. D'Annunzio University, Division of Cardiac Surgery, S. Camillo de' Lellis Hospital, via C. Forlanini, 50, 66100 Chieti Italy (E-mail: calafiore{at}unich.it).

Objective: If the aortic arch is clamped between the brachiocephalic trunk and the left common carotid artery and the brachiocephalic trunk is also clamped, the total ascending aorta can be replaced without circulatory arrest. Candidates for this technique need to have the following characteristics: preoperative demonstration of Willis polygon patency by means of transcranial Doppler ultrasonography, preoperative computed tomographic scan that shows no calcification in the arch or in the brachiocephalic trunk, and preoperative or intraoperative evidence of separate origins of the brachiocephalic trunk and the left common carotid artery.
Methods: In three different institutions (with different time frames in each) from December 2000 to December 2001, the possibility of replacing the total ascending aorta without circulatory arrest was evaluated in 14 cases. In 10 of them it was possible (feasibility of 71.4%). During the procedure continuous electroencephalographic monitoring was performed.
Results: No patient died in the early or midterm follow-up. None of the patients had any cerebral complications. The electroencephalographic activity was normal during the period of brachiocephalic trunk occlusion. In 5 patients a postoperative spiral computed tomographic scan showed good surgical results.
Conclusions: The technique described here allows replacement of the total ascending aorta without circulatory arrest in selected cases. Furthermore, the evidence of lack of right cerebral hypoperfusion in all the procedures we performed allows future exploration of the possibility of avoiding cerebral monitoring.






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