A complex surgical approach using a branch-first technique and adaptive perfusion can successfully manage type I aortic dissection complicated by cerebral malperfusion and multiple supra-aortic vessel lesions.
May support branch-first adaptive perfusion in complex type I dissection; hypothesis-generating and requires prospective validation.
We present surgical treatment of type I aortic dissection complicated by cerebral malperfusion. The patient with stenosis of innominate artery, detachment and dissection of the left subclavian artery, kinking of carotid arteries, hemodynamically significant left vertebral artery, intracranial aneurysm of the right internal carotid artery underwent replacement of supra-aortic vessels, ascending aorta and aortic arch (elephant trunk procedure using vascular trifurcation prosthesis under adaptive perfusion). Branch-first technique was used. Cannulation of both axillary arteries, adaptive loop of heart-lung machine and additional arterial pump provided cerebral circulation through the temporary axillary-axillary shunt at the stage of replacement of supra-aortic vessels. We were able to correct circulatory parameters in accordance with the stage of surgery. The second stage implied descending thoracic aorta stenting.
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Мироненко et al. (2023) studied this question.
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