• Konstantinos Tsagakis, Daniel Sebastian Dohle, Daniel Wendt, Wolf Wiese, Jaroslav Benedik, Helmut Lieder, Matthias Thielmann, and Heinz Jakob.
• a Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen , Essen, Germany.
• Minim Invasive Ther Allied Technol. 2015 Jan 1; 24 (5): 311-6.

IntroductionThe frozen elephant trunk (FET) technique enables combined aortic arch and descending aortic repair. We report our experience with a modified arch replacement technique by rerouting of the left subclavian artery (LSA) and fixation of the FET in Zone 2 or proximally under selective perfusion of all three arch arteries and the downstream aorta.Material And MethodsFrom January 2005 to December 2014, 78 of 173 patients operated with the FET technique underwent rerouting of the LSA. Rerouting was performed as aortic-subclavian, aorto-axillary or carotid-subclavia bypass. Hypothermic selective antegrade cerebral perfusion was established for cerebral protection. A separate cardiopulmonary bypass circuit was added for selective LSA and downstream aorta perfusion during the arch repair.ResultsIn-hospital mortality, stroke and paraplegia rates were 10%, 8% and 2.5%, respectively. LSA rerouting enabled total arch repair in <60 minutes of selective cerebral perfusion (mean 56 ± 15). No recurrent nerve palsy occurred. The selective perfusion of the downstream aorta led to the reduction of the distal hypothermic circulatory arrest time close to 30 minutes (p < 0.0001).DiscussionLSA rerouting facilitates arch aortic repair by FET surgery. The selective perfusion of all arch arteries and the downstream aorta during open arch repair reduces the ischemic times and may improve organ protection.

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