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Medicina
Special Issues
Recent Advances in Aortic Arch Surgery
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Recent Advances in Aortic Arch Surgery

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (10 April 2023) | Viewed by 4619

Special Issue Editors

Dr. Maximilian Luehr

E-Mail Website
Guest Editor
Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
Interests: cardiac surgery; thoracic endo-vascular repair (TEVAR); aortic disease; acute aortic dissection; Marfan syndrome; connective tissue disease; cerebral and spinal protection
Prof. Dr. Martin Czerny

E-Mail Website
Guest Editor
Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
Interests: aortic medicine; limited access valve surgery

Special Issue Information

Dear Colleagues,

Aortic arch surgery has evolved significantly with regard to perioperative management, surgical strategies and commercially available devices over the past 10 years. As one of the most challenging and complex endeavors in modern cardiovascular surgery, successful aortic arch surgery requires thorough preoperative planning by a dedicated interdisciplinary aortic team. Organ protection through temperature management, use of various cannulation sites, and the application of intraoperative neuromonitoring are key factors that have to be considered by the operating surgeon in the elective and emergent setting and are under constant advancement to further reduce operative morbidity and mortality in high-risk patients.

This Special Issue aims to explore the latest updates in the management of open, hybrid, and endovascular aortic arch surgery. Recent developments and current trends to successfully treat the aortic arch are thoroughly discussed by leading experts in the context of new experimental and recent clinical studies.

Dr. Maximilian Luehr
Prof. Dr. Martin Czerny
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • aortic arch surgery
  • hybrid arch procedures
  • frozen elephant trunk
  • endoarch
  • selective cerebral perfusion
  • neuromonitoring
  • moderate hypothermia
  • temperature management
  • neuroprotection
  • cannulation sites
  • aortic dissection (Stanford A, B, Non-A-Non-B)
  • aortic arch aneurysm
  • connective tissue disorders (Marfan, Loeys–Dietz, Ehlers–Danlos, Turner syndrome)
  • supra-aortic debranching
  • extra-anatomic bypass
  • aortic remodeling

Published Papers (2 papers)

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Research

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8 pages, 418 KiB  
Article
A Strategy for Minimizing Circulatory Arrest Duration in Complex Aortic Arch Procedures
by Robert Balan, Petar Soso, Parwis Massoudy, Till Proschek, Wiebke Kurre and Christian Mogilansky
Medicina 2023, 59(6), 1007; https://doi.org/10.3390/medicina59061007 - 24 May 2023
Cited by 1 | Viewed by 3066
Abstract
Background and Objectives: Aortic arch pathologies represent a surgical challenge. The challenge is partly due to the necessity of complex cerebral, visceral, and myocardial protection measures. Aortic arch surgery generally requires a significant duration of circulatory arrest, which includes deep hypothermia levels [...] Read more.
Background and Objectives: Aortic arch pathologies represent a surgical challenge. The challenge is partly due to the necessity of complex cerebral, visceral, and myocardial protection measures. Aortic arch surgery generally requires a significant duration of circulatory arrest, which includes deep hypothermia levels with the associated sequelae. This retrospective observational study shows the feasibility of a strategy that reduces circulatory arrest duration and eliminates the need for deep hypothermia during the procedure. Materials and Methods: Between January 2022 and January 2023, 15 patients (n = 15) with type A aortic dissection underwent total arch replacement with a frozen elephant trunk. Cardiopulmonary bypass and organ perfusion were established via arterial lines in the right axillary artery and one of the femoral arteries. In the latter vessels, a y-branched arterial cannula was used (ThruPortTM), allowing for endo-clamping of the stent part of the frozen elephant trunk with a balloon and subsequent perfusion of the lower body. Results: Applying this modified perfusion technique, circulatory arrest time could be reduced to a mean of 8.1 ± 4.2 min, and surgery was performed at a mean lowest body temperature of 28.9 ± 2.3 °C. The mean ICU and hospital stays were 18.3 ± 13.7 days and 23.8 ± 11.7 days, respectively. The rate for 30-day survival was 100%. Conclusions: By applying our modified perfusion technique, the circulatory arrest duration was below ten minutes. As a consequence, deep hypothermia could be avoided, and surgery could be performed at moderate hypothermia. Future studies will have to show whether these changes may be translated into a clinical benefit for our patients. Full article
(This article belongs to the Special Issue Recent Advances in Aortic Arch Surgery)
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Review

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9 pages, 2476 KiB  
Review
Training in Aortic Arch Surgery as a Blueprint for a Structured Educational Team Approach: A Review
by Philipp Discher, Maximilian Kreibich, Tim Berger, Stoyan Kondov, Matthias Eschenhagen, David Schibilsky, Magdalena Bork, Tim Walter, Salome Chikvatia, Roman Gottardi, Bartosz Rylski, Matthias Siepe and Martin Czerny
Medicina 2023, 59(8), 1391; https://doi.org/10.3390/medicina59081391 - 29 Jul 2023
Viewed by 935
Abstract
Background and objectives: The treatment of pathologies of the aortic arch is a complex field of cardiovascular surgery that has witnessed enormous progress recently. Such treatment is mainly performed in high-volume centres, and surgeons gain great experience in mastering potential difficulties even under [...] Read more.
Background and objectives: The treatment of pathologies of the aortic arch is a complex field of cardiovascular surgery that has witnessed enormous progress recently. Such treatment is mainly performed in high-volume centres, and surgeons gain great experience in mastering potential difficulties even under emergency circumstances, thereby ensuring the effective therapy of more complex pathologies with lower complication rates. As the numbers of patients rise, so does the need for well-trained surgeons in aortic arch surgery. But how is it possible to learn surgical procedures in a responsible way that, in addition to surgical techniques, also places particular demands on the overall surgical management such as perfusion strategy and neuro-protection? This is why a good training programme teaching young surgeons without increasing the risk for patients is indispensable. Our intention was to highlight the most challenging aspects of aortic arch surgery teaching and how young surgeons can master them. Materials and Methods: We analysed the literature to find out which methods are most suitable for such teaching goals and what result they reveal when serving as teaching procedures. Results: Several studies were found comparing the surgical outcome of young trainees with that of specialists. It was found that the results were comparable whether the procedure was performed by a specialist or by a trainee assisted by the specialist. Conclusions: We thus came to the conclusion that even for such a complex type of intervention, the responsible training of young surgeons by experienced specialists is possible. However, it requires a clear strategy and team approach to ensure a safe outcome for the patient. Full article
(This article belongs to the Special Issue Recent Advances in Aortic Arch Surgery)
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