The Heart Surgery Forum, Volume 7, Issue 3

Partial Clamping of the Brachiocephalic Trunk for Total Ascending Aorta Replacement without Circulatory Arrest: Early and Midterm Results

Antonio Maria Calafiore, MD,¹ Michele Di Mauro, MD,² Carlos-A. Mestres, MD,³ Gabriele Di Giammarco, MD,² Giovanni Teodori, MD,¹ José L. Pomar, MD,³ Luca Weltert, MD,¹ Antonio Bivona, MD,² Massimo Gagliardi, MD,² Angela Lorena Iaco, MD²

¹Division of Cardiac Surgery, University Hospital, Torino, Italy; ²Department of Cardiology and Cardiac Surgery, "G. D'Annunzio" University, Chieti, Italy; ³Department of Cardiovascular Surgery, Hospital Clinico, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain

ABSTRACT

Background: The aim of this study was to evaluate in elective patients the early and midterm results of partial clamping of the brachiocephalic trunk (BCT) for total ascending aorta replacement (TAAR) without circulatory arrest. Contraindications to the procedure were BCT/aortic arch calcifications and chronic aortic dissection.

Methods: The right radial artery was cannulated to monitor the systemic pressure after the BCT was partially clamped. A specially designed clamp was applied obliquely to occlude approximately 50% of the BCT and part of the aortic arch. The distal tip of the clamp was positioned in front of the left subclavian artery. From January 2002 to October 2003, 92 patients underwent TAAR. In 62 patients (67.4%), partial clamping of the BCT was used. Twenty of these patients underwent isolated TAAR, 27 underwent aortic valve replacement and TAAR, 11 had a Bentall operation, and 2 had a Cabrol operation. The aortic valve was spared in the remaining 2 patients. The mean (± SD) aortic cross-clamping and cardiopulmonary bypass times were 96 ± 31 minutes and 116 ± 43 minutes, respectively.

Results: Early mortality was 1.6% (1 patient). No cerebrovascular accidents occurred, demonstrating the safety of the technique. The major complications were acute respiratory insufficiency in 2 cases and acute renal failure in 5. The mean follow-up time was 9.0 ± 6.5 months. The mean 18- month and event-free survival rate was 96.6% ± 0.9%.

Conclusion: Partial clamping of the BCT for TAAR without circulatory arrest provides good early and midterm clinical results. Aortic arch clamping is not associated with cerebrovascular accidents.

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