Aortic arch repair and replacement are surgical procedures performed to treat conditions affecting the aortic arch, which is the curved portion of the aorta that arises from the heart and gives rise to the brachiocephalic trunk, left common carotid artery, and left subclavian artery. These procedures aim to address abnormalities or pathologies in the aortic arch and restore normal blood flow. Here are some common approaches for aortic arch repair and replacement:

1. Open Aortic Arch Repair: This procedure involves making an incision in the chest to access the aortic arch directly. The diseased or damaged portion of the aortic arch is removed, and a graft made of synthetic material is used to replace the removed segment. The graft is then connected to the remaining healthy segments of the aorta. This technique requires the use of cardiopulmonary bypass, during which the heart is temporarily stopped and blood circulation is maintained using a heart-lung machine.

2. Hybrid Aortic Arch Repair: In some cases, a hybrid approach may be used, combining open surgery with an endovascular procedure. This approach involves making a small incision in the chest to access the ascending aorta, followed by the placement of a stent graft or stent fenestration through the blood vessels to treat specific portions of the aortic arch.

3. Frozen Elephant Trunk Procedure: The frozen elephant trunk procedure is a combination of open surgery and endovascular techniques. It involves replacing the diseased portion of the aortic arch using a hybrid graft that combines a conventional synthetic graft and a stent graft. This procedure allows for simultaneous repair of the aortic arch and descending aorta.

4. Aortic Arch Replacement: In cases where the entire aortic arch is affected, aortic arch replacement may be necessary. During this procedure, the entire aortic arch, including the brachiocephalic vessels, is removed, and a synthetic graft is used to replace the entire arch. The graft is then connected to the remaining portions of the aorta.

INDICATIONS

Aortic arch repair and replacement are surgical procedures that are indicated for various conditions affecting the aortic arch. The specific indications for aortic arch repair and replacement depend on the underlying pathology and the patient’s symptoms. Here are some common indications for these procedures:

1. Aortic Aneurysm: Aortic aneurysms involving the aortic arch may require repair or replacement. An aneurysm is an abnormal dilation or bulge in the wall of the aorta. If an aortic arch aneurysm reaches a certain size or poses a risk of rupture, surgical intervention may be necessary to prevent life-threatening complications.

2. Aortic Dissection: Aortic dissection is a condition in which there is a tear in the inner layer of the aortic wall, causing blood to flow between the layers and potentially leading to a life-threatening situation. If the dissection involves the aortic arch, surgical repair or replacement may be indicated to prevent further progression of the dissection and restore normal blood flow.

3. Aortic Arch Atherosclerosis: Atherosclerosis refers to the buildup of plaque within the arteries. If the aortic arch becomes severely affected by atherosclerosis, leading to compromised blood flow or causing symptoms, surgical intervention may be considered to remove the plaque or replace the affected segment of the aorta.

4. Aortic Arch Atheroma or Ulcer: Atheroma or ulcer formation in the aortic arch can lead to embolization of plaque or debris, which can cause strokes or other vascular complications. In some cases, surgical repair or replacement of the aortic arch may be indicated to remove the atheromatous plaque or repair the ulcer and prevent further embolic events.

5. Connective Tissue Disorders: Patients with connective tissue disorders, such as Marfan syndrome, Ehlers-Danlos syndrome, or Loeys-Dietz syndrome, are at an increased risk of developing aortic pathology, including aortic arch involvement. If the aortic arch becomes affected in these individuals, surgical repair or replacement may be necessary.

CONTRAINDICATION:

Contraindications for aortic arch repair and replacement may vary depending on the specific surgical technique, the patient’s condition, and other factors. However, some general contraindications may include:

1. Advanced age and poor general health: Advanced age and poor general health may increase the risk of complications associated with aortic arch repair and replacement. In these cases, the patient’s overall health status and ability to tolerate the surgery and postoperative recovery will be carefully evaluated.

2. Severe comorbidities: Patients with severe comorbidities, such as chronic lung disease, liver disease, kidney disease, or cancer, may not be good candidates for aortic arch repair and replacement due to the increased risk of complications.

3. Uncontrolled bleeding disorders: Patients with uncontrolled bleeding disorders, such as haemophilia or von Willebrand disease, may be at an increased risk of bleeding during the surgery and postoperative recovery.

4. Unstable cardiovascular status: Patients with unstable cardiovascular status, such as unstable angina or acute myocardial infarction, may not be good candidates for aortic arch repair and replacement due to the increased risk of complications.

5. Inability to tolerate general anaesthesia: Aortic arch repair and replacement are typically performed under general anaesthesia. Patients who cannot tolerate general anaesthesia may not be candidates for these procedures.