Published: May 1, 2008
Updated: Aug. 17, 2010
Aortic arch reconstruction techniques vary depending on the arch pathology, and some arches may need to be replaced in anticipation of the later replacement of the descending thoracic aorta.
Surgical treatment of aneurysms of the ascending aorta and aortic arch frequently require the use of specialized perfusion techniques, including deep hypothermic circulatory arrest (DHCA), to ensure protection of the central nervous system while allowing complete repair of the anatomical defect.
Patients with aortic arch aneurysms have historically been underserved due to the risk of cerebral ischemia during restorative surgery. Recent technical developments have allowed surgeons to maximize neurological protection.
Our thoracic aortic surgery team includes certified cardiac perfusionists with long-term experience in these complex perfusion strategies. The team also includes cardiac anesthesiologists with a sub-specialty interest in aortic surgery and the expertise required to care for these complicated patients.
Further, patients undergoing these procedures have online monitoring of their central nervous system with electroencephalography (EEG) by our neurophysiologic monitoring service during their operation to guide brain protection and ensure safety.
Duke is one of the few centers in the country that offers "hybrid" repairs for thoracoabdominal and aortic arch aneurysms. This technique is a combination of open debranching and endovascular aneurysm exclusion, which eliminates the need for cardiopulmonary bypass and aortic cross-clamp.
The hybrid technique is a safer alternative to open surgery for many patients, making it an option for high-risk patients who cannot undergo conventional open surgery. It's especially suited to patients with other significant health problems or prior open aortic surgery.