title: Aortic arch replacement and elephant trunk procedure: an interdisciplinary approach to surgical reconstruction, perfusion strategies and blood management.
abstract: Surgical treatment of patients who present with large aneurysms of the ascending aorta, transverse arch and descending aorta, including the thoracic and abdominal aorta typically consists of a two-staged elephant trunk procedure. Typically, these operations are lengthy, requiring long cardiopulmonary bypass times, deep hypothermic circulatory arrest and multiple anastamotic suture lines, which increases the risks for coagulopathic bleeding and the need for massive transfusions. The purpose of this report is to describe our approach, involving advanced surgical techniques and the innovative perfusion considerations as well as modified blood management strategies to minimize perioperative blood loss and the need for transfusions. All of the above will highlight critical cardiac team communications. An ever-evolving case requires forward thinking, revised judgments, open discussion and the continued involvement of all team members. In turn, this ensures evidence-based medical and perfusion practices that lead to achieving a positive peri-operative course, with optimal blood conservation.
authors.affiliation: Clinical Perfusion Services, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: McKay
authors.forename: Peter
authors.initials: P
authors.lastname: Allen
authors.forename: Philip M
authors.initials: PM
authors.lastname: Jones
authors.forename: Michael W A
authors.initials: MW
authors.lastname: Chu
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D016896:Treatment Outcome