Indications for repair include aneurysms greater than 6 cm in diameter, aortic arch dissections, and ascending arch aneurysms that extend into the transverse arch.
Operative management. After opening the aorta under hypothermic circulatory arrest, the distal anastomosis is performed using a beveled graft, followed by anastomosis of an island of the brachiocephalic vessels to the superior aspect of the graft. The proximal anastomosis is constructed to the supracoronary aorta (if the aortic valve is not involved) or to a segment of composite valved conduit interposed to complete the arch reconstruction. Involvement of the transverse arch and its branch vessels requires interposition grafting to the involved vessels.
Descending Thoracic Aortic Aneurysm
Indications for repair include symptomatic aneurysms and asymptomatic aneurysms greater than 6 cm in diameter.
Operative management.Before cross-clamping, the anesthesiologist pharmacologically controls proximal blood pressure. After the distal clamp is applied, a proximal clamp is placed just distal to the left subclavian artery or between the left common carotid and left subclavian arteries. Selected intercostal branches are reattached to the aortic interposition graft. Use of left heart partial bypass is a valuable adjunct, and catheter-based drainage of cerebrospinal fluid may reduce the incidence of postoperative paraplegia.
