title: "Open" approach to aortic arch aneurysm repair.
abstract: Aortic arch aneurysm is a relatively rare entity in cardiac surgery. Repair of such aneurysms, either in isolation or combined with other cardiac procedures, remains a challenging task. The need to produce a relatively bloodless surgical field with circulatory arrest, while at the same time protecting the brain, is the hallmark of this challenge. However, a clear understanding of the topic allows a better and less morbid approach to such a complex surgery. Literature has shown the advantage of selective cerebral perfusion techniques in comparison with only circulatory arrest. Ability to perfuse the brain has allowed circulatory arrest temperatures at moderate hypothermia without the need for deep hypothermia. Even though cannulation site selection appears to be a minor issue, literature has shown that the subclavian/axillary route has the best outcomes and that femoral cannulation should only be reserved for no access patients. Although different techniques for arch anastomosis have been described, we routinely perform the distal first technique as we find it to be less cumbersome and easiest to reproduce. In this review our aim is to outline a systematic approach to aortic arch surgery. Starting with indications for intervention and proceeding with approaches on site of cannulation, approaches to brain protection with hypothermia and selective cerebral perfusion and finally surgical steps in performing the distal and arch vessels anastomosis.
authors: Division of Cardiothoracic Surgery, Department of Surgery, Sultan Qaboos University Hospital, Muscat.
authors: Adil H
authors: AH
authors: Al Kindi
authors: Division of Cardiac Anesthesia, Department of Anesthesia, Sultan Qaboos University Hospital, Muscat.
authors: Nasser
authors: N
authors: Al Kimyani
authors: Division of Cardiothoracic Surgery, Department of Surgery, Sultan Qaboos University Hospital, Muscat.
authors: Tarek
authors: T
authors: Alameddine
authors: Division of Cardiothoracic Surgery, Department of Surgery, Sultan Qaboos University Hospital, Muscat.
authors: Qasim
authors: Q
authors: Al Abri
authors: Division of Cardiothoracic Surgery, Department of Surgery, Sultan Qaboos University Hospital, Muscat.
authors: Baskaran
authors: B
authors: Balan
authors: Division of Cardiothoracic Surgery, Department of Surgery, Sultan Qaboos University Hospital, Muscat.
authors: Hilal
authors: H
authors: Al Sabti
keywords: Aortic arch aneurysm; Distal first anastomosis; Hypothermic circulatory arrest; Open repair; Selective cerebral perfusion