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Modified Branch-first Open Repair of Thoracoabdominal Aortic Aneurysm- A Technical Description

  • Niranjan Hiremath
    Correspondence
    Address reprint requests to Niranjan Hiremath, MCh, FVES, FACS(Aus), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute, Associate Staff Physician Cardiac surgery, Heart and Vascular Institute, Cleveland Clinic Al Maryah Island, 112412, Abu Dhabi, UAE United Arab Emirates.
    Affiliations
    Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute, Associate Staff Physician Cardiac surgery, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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  • Gopal Bhatnagar
    Affiliations
    Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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  • Khubaib Mapara
    Affiliations
    Department of Vascular Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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  • Houssam Younes
    Affiliations
    Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Department of Vascular Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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  • Woosup Michael Park
    Affiliations
    Department of Vascular Surgery, Cleveland Clinic Foundation, Abu Dhabi, United Arab Emirates
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      The current conventional open TAAA repairs are performed by select centers around the world with good outcomes. However, lesser experienced centers often encounter difficulties in replicating similar results of open TAAA surgeries. The modified branch-first open repair of TAAA has shown to be effective in minimizing visceral and renal complications by providing continuous visceral blood flow throughout the procedure. By debranching the visceral vessels first, we can perform this complex aortic procedure in a more controlled manner as compared to the traditional clamp and sew technique which requires speed, precision and experience. The entire repair can be performed on beating heart by deriving native blood flow via a closed circuit or a modification of the left heart bypass and continuously perfusing the abdominal viscera, thus avoiding cardiopulmonary bypass or deep hypothermic circulatory arrest which helps minimize bleeding and overall morbidity associated with extensive TAA surgeries. Adequate pre-operative planning is imperative to prevent spinal cord complications and intra-operative emergencies.

      Keywords

      Abbreviations:

      TAAA (Thoracoabdominal Aortic Aneurysm), MBFT (Modified Branch-first Technique), TAA (Thoracoabdominal Aortic), CPB (Cardiopulmonary Bypass), DHCA (Deep Hypothermic Circulatory arrest)
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