Arterial Cannulation Through Aneurysm and Aortic Anastomosis During Proximal Thoracic Aortic Aneurysm Surgery

Background: Proximal aortic aneurysm surgery involving the aortic root and ascending aorta represents a specific surgical intervention in terms of the number of surgical incisions, arterial cannulation methods as well as anastomosis technique and cerebral protection. This study aims to present a case series of a new surgical technique for proximal aortic aneurysm surgery exclusively through midsternal approach and consisting of arterial cannulation from the aneurysmatic segment and through aortic anastomosis. Methods: This retrospective study included 90 patients who were operated for proximal thoracic aortic aneurysm using a new surgical technique mainly consisting of single standard midsternal approach without extension of the incision, arterial cannulation through the aneurysmatic segment and aortic anastomosis, deep hypothermic circulatory arrest, and open distal anastomosis without cerebral perfusion. Results: Ascending aorta replacement (replacement) and ascending aorta replacement plus aortic root replacement (ARR) was performed in 60 (66.7%) and 30 (33.3%) patients, respectively. Intraoperative courses were uneventful. The mean durations for deep hypothermic circulatory arrest (DHCA), cross-clamp, and cardiopulmonary bypass were 24.9 ± 3.2 min, 169.7 ± 52.8 min, and 235.3 ± 57.6 min, respectively. Most common postoperative complication was atrial fibrillation (18.9%) followed by inotropic need (10%) and wound infection (7.8%). Three patients died (3.3%) during hospitalization. Conclusions: This new method for the treatment of proximal aortic aneurysms offers a viable and safe alternative with only midsternal surgical incision, without damaging any segment of the healthy aortic tree for arterial cannulation, without prolonging the operation time, and avoiding complications related to additional incisions and cannulation of the healthy aortic tree.