Editor-in-Chief Ufuk Demirkılıç Frequency Quarterly Abbreviation Turk J Vasc Surg Publisher Turkish National Vascular and Endovascular Surgery Society E-ISSN 2667-5080

Turkish Journal of Vascular Surgery 2022 , Vol 31 , Issue 2
Branch-first approach in aortic dissection: Initial results
Bülent Mert1, Adil Polat1
1Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, Istanbul, Türkiye DOI : 10.9739/tjvs.2022.1236 Objectives: This study aims to evaluate the outcomes of "branch-first" approach in aortic arch repair in aortic dissection for the first time in Türkiye.

Patients and methods: Between January 2015 and December 2021, a total of 20 patients (18 males, 2 females; mean age: 51.3±11.1 years; range, 36 to 82 years) who underwent surgery for arch branches were retrospectively analyzed. The "branch-first" approach was used for the perfusion strategy and the repair was commenced accordingly. We used innominate artery and femoral artery for most cases as the primary arterial line and the secondary line was performed at one of the arch branches according to the preoperative imaging findings. These areas were used for the consecutive branch anastomosis.

Results: Overall 30-day mortality occurred in three (15%) patients. Thirteen (65%) patients had postoperative morbidity. Postoperative stroke was seen in one (5%) patient and the most common morbidity was revision surgery for bleeding in five (25%) patients. During follow-up, one patient had debranching graft stenosis (5%), but had no clinical problems. According to the Kaplan-Meier analysis, the mean one- and two-year survival rates were 91.7±8.0% and 78.6±13.9%, respectively.

Conclusion: The "Branch-first" technique is a feasible technique for aortic dissection repairs, when the arch branches should be intervened. The mortality is compatible with the literature and the morbidity is low. Keywords : Aortic arch, aortic dissection, branch-first, debranching, perfusion strategy

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