Case 3
Isolated Aortic Arch Dissection
A 70 year old lady presented with tearing chest pain, a widened mediastinum on CXR, and an isolated dissection involving the aortic arch, associated with a mediastinal haematoma. What are the options ?
Conservative - As any surgical intervention in an emergency situation must be classified as high risk.
Classic surgical approach via median sternotomy, a circulatory arrest and a total arch replacement.
Hybrid procedure - Perform a median sternotomy, and perform an extra anatomical bypass from the ascending aorta to the left and right carotid artery. This can be done without bypass. Barbiturates may help in cerebral protection with reduced cerebral blood flow during partial clamping of the carotid arteries during the anastomosis. After the extra anatomical bypass has been performed the aortic arch can be stented in its entirety. Should their be a problem with the left arm, an extra anatomical bypass can be performed.