Aortic Arch Replacement in Mild Hypothermia (30°)

A relatively new surgical concept for aortic arch surgery provides full, warm perfusion (blood flow) to the patient, thereby reducing operative time, postoperative neurological complications, and mortality.

Traditional aortic arch replacement operations require the patient to maintain a body temperature of 18° and to maintain circulatory arrest. Deep cooling of the patient is necessary because this prevents damage to the brain, nerves, and gastrointestinal tract due to lack of blood flow.

However, this severe hypothermia and rewarming of the patient, as well as the surgery duration extending for several hours, also creates a great burden on the patient.

A new approach developed by our team provides full, warm (30-32°) perfusion (blood flow) to the patient’s brain during surgery, reducing operative time, postoperative neurological complications, and ultimately mortality.

Operation technique:

The patient is connected to a heart-lung machine via the right subclavian artery to first provide blood flow to the whole body and then to provide full perfusion (blood flow) to the brain. The brachiocephalic artery (the right main artery of the brain) and the left subclavian and carotid arteries are clamped to provide the necessary pressure conditions in the head. This means that the vascular prosthesis (distal anastomosis) can be implanted “bloodlessly” into the aortic arch.

Results:

Our studies have shown that this new method represents a suitable alternative to conventional cooling. The very high risk of side effects resulting from severe hypothermia and prolonged work on a heart-lung machine can thus be reduced.

Theoretically, the risk of damage to the spinal cord, kidneys, and internal organs that are not supplied with blood increases during proximal anastomosis, but this has not been proven by previous studies.

Aortic arch replacement for mild hypothermia is now part of our team’s standard procedure, with cases in over 400 patients and also performed in other clinics. The traditional method is used only in exceptional cases.