Although this technique seemed very attractive at the beginning, the supporting outcome data was limited and to date, there are no reported randomized trial confirming the superiority of hybrid over open repair. The very first case of successful hybrid aortic arch repair through debranching of epiaortic vessels and simultaneously stenting the diseased aortic arch was performed by Czerny et al. In another step to support the demand in reducing the morbidity and mortality surrounding open aortic arch surgery, endovascular techniques came into practice and hybrid techniques have evolved. Furthermore, aortic surgeons have not stopped at this level but explored other options aiming to reduce the perioperative morbidity and in particular the neurological complications to the lowest possible rate through using a higher temperature than DHCA, which involved moderate or even mild hypothermic circulatory arrest in adjunct with RCP, ACP, or sACP. Among such advancements, in addition to the use of deep hypothermic circulatory arrest (DHCA), are the use of retrograde cerebral perfusion (RCP) and afterward the use of antegrade cerebral perfusion (ACP), and more recently, the advent and use of selective ACP (sACP) in certain cases of complex aortic arch repair. Thereafter, several other techniques have evolved to reduce the rate of neurological complications and more seriously the mortality rates. published a case series of four patients that underwent successful aortic arch repair using deep hypothermic circulatory arrest combined with cardiopulmonary bypass. However, as this procedure involves depriving the brain from its blood supply, the technique has evolved dramatically and in 1975, the breakthrough came when Griepp et al. in 1955 since then, open arch repair became the standard management option for any patient presenting with aortic arch diseases. The very first open aortic arch reconstruction surgery was performed by Cooley et al. Treating aortic arch pathologies are complex and pose a substantial challenge to the cardiovascular surgeons.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |