Simplified Arch-first Technique in Aortic Arch Branches Replacement: Perfusion without Cardiopulmonary Bypass

Introduction： Surgery is the mainstay of treatment for aortic dissection which lesion affected the aortic arch. Conventional surgical methods usually use unilateral cerebral perfusion by cardiopulmonary bypass (CPB) to maintain the perfusion of the brain, and the reconstruction of arch branches must be performed under CPB. Unilateral cerebral perfusion with prolonged CPB may lead to complications of cerebral hypoperfusion. We propose a new technique that can accomplish aortic arch branches replacement without the use of cardiopulmonary bypass and maintain bilateral cerebral perfusion at all times. Materials and Methods: From January 2018 to July 2021, we performed the new technique in 23 patients. Furthermore, we performed a retrospective analysis with patients undergoing conventional surgery during the same period, comparing perioperative data and follow-up data between two groups. Result: The CPB time, deep hypothermic circulatory arrest time and aortic cross-clamping time of new technique group was significantly shorter than conventional group. Other perioperative data and follow-up data were not statistically different. Discussion: Simplified arch-first technique can significantly shorten CPB, aortic cross-clamping and deep hypothermic circulatory arrest time. The technique is theoretically safer because it can better protect the cerebral perfusion during the operation. The short-term efficacy of this technique is the same as that of conventional surgery, and it is more convenient for surgeons to operate. Conclusions: Compared with the conventional method, the simplified arch-first technique is non-inferior, friendly in operation and safer in theory, and is worthy of promotion.