title: Patient management in aortic arch surgery†.
abstract: SummaryAortic arch surgery requires complex patient management beyond the manual replacement of the diseased vessel. These procedures include (i) a thorough and pathologically adjusted preoperative evaluation, (ii) initiation and control of cardiopulmonary bypass, (iii) cerebral protection strategies and (iv) techniques to protect the abdominal end organs during prolonged operations. Due to the complexity of aortic arch procedures, multimodal real-time surveillance is required during all stages of the operation. Although having the patient survive the operation is the major goal, further observation is necessary because of the chronicity of the disease. This review summarizes specific aspects of patient management during and after operations requiring periods of circulatory arrest, without necessarily referring to all studies on this topic. The pros and cons of different strategies are weighed against each other, including the personal experience of the authors. A number of questions are raised without providing a 'right' or 'wrong' answer. We show that a number of different well-established strategies can result in comparable excellent long-lasting surgical results.
authors.affiliation: Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilian University, Munich, Germany.|Aortic Institute, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Sven
authors.initials: S
authors.lastname: Peterss
authors.affiliation: Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilian University, Munich, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Pichlmaier
authors.affiliation: Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Curtis
authors.affiliation: Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilian University, Munich, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Luehr
authors.affiliation: Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilian University, Munich, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Born
authors.affiliation: Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilian University, Munich, Germany christian.hagl@med.uni-muenchen.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D002545:Brain Ischemia / Q000517:prevention & control; D006328:Cardiac Catheterization / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods; D019468:Disease Management; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods; D009483:Neuropsychological Tests; D019990:Perioperative Care / Q000379:methods*
keywords: Aneurysm; Aortic arch surgery; Cerebral protection; Dissection; Perioperative monitoring; Visceral protection