Open aortic arch surgery-how we do it

Abstract

Open aortic arch surgery is still challenging even in the present era with the Achilles' heel being the neurological complication. The variety of approaches and surgical techniques used to reconstruct the aortic arch, protecting the vital organs, the extent of aortic replacement, and the options of reimplanting the supra-aortic arch vessels indicate the challenges involved in the procedure. Though open surgery still remains the 'gold standard', in the last two decades, endo-prostheses and stents have emerged as alternate options.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-023-01574-9.

Keywords: Aortic arch; Aortic arch pathology; Aortic surgery.

Fig. 1

Cartoon to depict the steps involved in establishing bilateral antegrade cerebral perfusion in a patient who had right axillary artery cannulation. The brown line depicts antegrade cerebral perfusion to the left common carotid artery

Fig. 2

Aortic arch reconstruction: (A) Hemiarch replacement by ‘peninsular technique’, (B) Island patch technique, (C) Individual branch anastomosis

Fig. 3

Aortic arch surgery in extensive aortic arch disease: (A) Single-stage retrograde replacement of the thoracic aorta; (B) Three types of hybrid aortic arch repair (HAAR); (C) Frozen elephant trunk