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OBJECTIVE: To analyse the feasibility and results of off-pump aortic arch debranching and stenting for treatment of aortic arch pathology, where a total circulatory arrest even with selective cerebral perfusion might be risky
METHODS: From June 2012 till April 2013, 7 patients with extensive aortic arch pathology, where an off-pump treatment strategy was prefered due to a past history of cerebrovascular accidents (CVA) in 3 patients and extensive renal insuficiency in the other 4. The aortic arch pathology included 4 aortic dissections and 3 aortic aneurysms. The patients underwent an off-pump arch debranching, followed by aortic arch stenting in the same setting. The aortic stent implantation was performed either via a standard transfemoral approach or in an antegrade manner via the ascending aorta.
RESULTS: The mean operative time was 184 min. No conversion to cardiopulmonary bypass support was needed. Rethoracotomy for bleeding was necessary in one patient. Postoperative dialysis was needed in one patient. a new CVA was reported in one patient. The 30-day mortality was one patient.
CONCLUSIONS: Off-pump aortic debranching with arch stenting is a feasible procedure that could be considered in patients with arch pathology. This treatment concept should be specially considered in patients with a history of CVA or severe renal insufficiency, as it alleviates the risks associated with total circulatory arrest, lowering the procedural risk and yielding more favourable results.