Objective

In patients with aortic arch aneurysms, a normal or previously replaced ascending aorta can sometimes be used as a landing zone for an endovascular stent. To enable this it is necessary to de-branch the aortic arch, repositioning the origin of the supra-aortic vessels to the proximal ascending aorta. This can be done off bypass, reducing the morbidity associated with circulatory arrest and hypothermia. We review our experience with these cases.

Methods

Using a prospectively maintained database, we identified all patients who underwent off-pump aortic arch de-branching with endovascular stent graft placement. Data were collected on pre-existing morbidity, surgical technique, post-operative complications and long-term survival.

Results

Between 9/3/07 and 18/9/15, seven patients underwent off-pump arch repair. Mean age was 61 years (range: 26 - 81 years). Aetiology was chronic dissection in two cases and degenerative in five. One patient had an emergency repair due to rupture. Endovascular stenting was performed intraoperatively in four patients via an antegrade transaortic route. There were two incidences of postoperative stroke and one in-hospital death. All other patients were still alive at a median follow up of 39 months.

Conclusion

Off pump aortic arch repair is feasible in selected patients and less complex than open arch replacement. Although results in this small series are not markedly superior to conventional surgical methods, off pump repair remains a promising treatment alternative for complex arch pathology.