NON-ANATOMICAL DEBRANCH OF THE SUPRA-AORTIC VESSELS DURING COMPLEX AORTIC SURGERY: EARLY AND MID-TERM RESULTS

Background: Several surgical techniques have been proposed over the years to treat aortic arch pathology, confirming the complexity of this disease. Our conventional approach is the «debranch-first technique» combined to frozen elephant trunk procedure (FET). In addition, an extra- anatomical bypass between the left common carotid artery and subclavian artery (CSB) is performed prior the main surgery. The aim of this study was to investigate the early and midterm results of this two-step-based procedure. Methods: Between 2012 and 2024, 87 patients underwent FET. The main indications were degenerative aortic aneurysm (26%), chronic aortic dissection (66.6%) and acute aortic syndrome (7%). REDO Aortic Surgery was performed in 61 patients (70%). EuroSCORE II and STS score were 5.85% and 1.93%, respectively. 78 patients (90%) were submitted CSB, prior to FET procedure. Both axillary arteries were cannulated; debranching first technique was performed during the cooling of the patient and - after the aortic arch replacement by a custom-made graft – at last sutured to the aortic graft. Results: 30-Days Mortality occurred in 12 patients (14%). 10 patients had a stroke (fatal for 2 patients). 5.8% suffered from a temporary spinal cord ischemia. The estimated 5-year overall survival was 64%. 23 patients were submitted to a second-step endovascular procedures (41%). Conclusions: The debranch – first technique with non- anatomical sovraortic vessels reimplantation and previous CSB represents a safe and effective method to address this complex pathology. A longer follow up is needed to confirm the goodness of this approach.