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. 2013 Mar;2(2):194-201.
doi: 10.3978/j.issn.2225-319X.2013.02.01.

"Branch-first" continuous perfusion aortic arch replacement and its role in intra-operative cerebral protection

George Matalanis  1 , Sean D Galvin
Affiliations

"Branch-first" continuous perfusion aortic arch replacement and its role in intra-operative cerebral protection

George Matalanis et al. Ann Cardiothorac Surg. 2013 Mar.
No abstract available

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Figures

Figure 1
Figure 1
Intra-operative image of the modified 3-branched Dacron graft (TAPP, Vascutek Ltd., Renfrewshire, Scotland, UK). This graft has the advantage of having an additional limb (held by forceps) which allows for antegrade cerebral perfusion following completion of each branch anastomosis and removes the need for separate axillary cannulation to supply inflow to the graft
Figure 2
Figure 2
Sequence of the “branch-first” aortic arch reconstruction. A. The innominate artery is clamped proximal to its bifurcation and distal to its origin from the arch. Right hemispheric cerebral perfusion is maintained through the left common carotid and subclavian arteries via collateral channels (see Figure 3); B. The innominate stump is ligated and the anastomosis to the branched graft completed; C. Antegrade right hemispheric cerebral perfusion is resumed via perfusion side arm. Left hemispheric cerebral perfusion during construction of the left common carotid anastomosis is maintained via the same collaterals (see Figure 3); D. Subclavian anastomosis is completed; E. Anastomosis of the arch graft to the distal arch. Note the clamped proximal arch allows continued perfusion of distal organs. Cardioplegia is now commenced; F. After completion of the root anastomosis, connection of the trifurcation graft to the ascending graft proceeds without interruption of cerebral perfusion
Figure 3
Figure 3
Apart from the circle of Willis there is a plethora of extra-cranial collateral channels that augment cerebral perfusion during individual clamping of branch vessels. These include collateral channels between (A) the external and internal carotid arteries; (B) the right and the left carotid arteries; (C) the upper and lower body; and (D) the subclavian and carotid arteries [Adapted from (21) and reproduced with permission from Elsevier]
See this image and copyright information in PMC

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