Use of temporary arterial shunt in surgery of dissection of the aorta and brachiocephalic arteries

Mironenko V.A., Garmanov S.V., Chegrina L.V., Shundrov A.S., Kokoev M.B.

A.N. Bakulev National Medical Research Centre of Cardiovascular Surgery, RF Ministry of Public Health, Moscow, Russia

Background. Unsolved problems of cerebral protection in operations on the aortic arch, especially in a combination with extension of dissection to the brachiocephalic arteries determine search for variants making it possible to carry out adequate cerebral perfusion.

Objective. To propose a new technique and initial experience of using cerebral perfusion through a temporary shunt from the basin of the left subclavian artery at the stage of prosthetic repair of brachiocephalic arteries.

Patients and methods. At the Department of Reconstructive Surgery and Aortic Root of A.N. Bakulev National Medical Research Centre of Cardiovascular Surgery, a total of 6 patients (5 men) with type A aortic dissection underwent a stage of restoration of brachiocephalic arteries with the use of a temporary arterial shunt. The mean age was 48±15 years. The patients had chronic aortic dissection involving brachiocephalic arteries, primary fenestration in the aortic arch. All were found to have signs of chronic cerebrovascular insufficiency (dizziness, loss of consciousness); 2 patients had a history of transitory focal impairments.

All patients were subjected to prosthetic repair of the ascending portion, aortic arch and all brachiocephalic arteries in conditions of adaptive perfusion with the use of adaptive loop from arterial lines. Supracoronary reconstruction of the ascending aorta was performed in 4 patients, Bentall operation in 2 subjects, with all undergoing total aortic arch replacement according to the elephant trunk technique. Brachiocephalic arteries were repaired using a trifurcated vascular grafts.

Results. Mean duration of cerebral perfusion along the temporary shunt amounted to 34±12 min. At all stages of operation, the level of haemoglobin oxygen saturation (rSO2) according to cerebral oximetry was within the reference values. All patients were discharged averagely on POD 12.

Conclusion. A novel technique of cerebral perfusion along a temporary shunt will make it possible to extend the capabilities of heart surgeons in complicated combined interventions on the aortic arch and brachiocephalic arteries.

KEY WORDS: aortic dissection, cerebral malperfusion, adaptive perfusion, adaptive loop of extracorporeal circuit, temporary arterial shunt, trifurcated vascular graft, cerebral perfusion through temporary shunt.

Р. 87

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