Technical Notes: Open Ascending Aorta and Valve Repair Following Total Arch Endovascular Repair.
Florent Porez, Robert Pruna-Guillen, Julien Guihaire et al.
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Case in brief
Two patients with prior arch-branched endovascular repair (B-TEVAR) underwent open surgery involving the ascending aorta and heart valves. One had ascending aortic replacement under circulatory arrest with selective bicarotid perfusion. The other underwent a Bentall procedure and mitral valve replacement using femoral-femoral bypass, balloon-based distal aortic control, and selective brachiocephalic trunk perfusion. Both operations were successful: one patient recovered uneventfully, while the other had a prolonged ICU stay followed by full recovery.
What made this case unusual
The report describes tailored open ascending aortic and valve operations after B-TEVAR, with different strategies for distal aortic control and cerebral perfusion shaped by the endograft and its branches.
Diagnostic / clinical pearl
Before open ascending aortic or valve surgery after B-TEVAR, assess endograft position and branch orientation on preoperative CT with 3D reconstruction, and plan the clamping and perfusion strategy accordingly.
Why it matters
As B-TEVAR use grows, clinicians may encounter complex open cardiac reoperations in patients with arch endografts; these cases show that such surgery can be feasible with tailored planning.