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Operative Techniques in Surgery of the Proximal Thoracic Aorta and Aortic Arch

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Anesthesia and Perioperative Care for Aortic Surgery

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Abstract

There is a strikingly uniform histopathology (cystic medial degeneration) inherent to most all diseases affecting the proximal thoracic aorta, and this pathology imparts a disruption of the structural integrity of the aortic wall giving rise to aneurysm formation, dissection, or rupture – the final common pathway of untreated proximal thoracic aortic disease. It is important to fully understand the clinical modes of presentation of proximal thoracic aortic disease as the surgical management and timing of intervention vary accordingly. Patient comorbidity, extent of thoracic aortic reconstruction required, and timing of surgery, all impact morbidity and mortality following proximal thoracic aortic surgery. The extent of reconstruction is predicated on the condition of the aortic root and the aortic valve, the presence of an underlying connective tissue disorder, the life expectancy of the patient, the desired anticoagulation status, the need for associated cardiac procedures, as well as surgeon experience. The ultimate outcome of patients undergoing these procedures depends on thorough preoperative surgical ­planning; meticulous myocardial, cerebral, and spinal cord protection; precise operative technique; and dutiful postoperative care. Thoracic aortic surgery is complex and mandates a seamless interaction between surgeons and cardiac anesthesiologists to ensure optimal patient outcomes.

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Authors and Affiliations

  1. Division of Cardiac Surgery, Department of Surgery, Thoracic Transplantation and Mechanical Circulatory Support, Heart Transplantation Program, Scott & White Clinic, Texas A&M Helath Science Center College of Medicine, Scott & White Hospital and Clinics, Temple, TX, USA

    Enrique Gongora

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  1. Enrique Gongora
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  2. Thomas G. Gleason
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Correspondence to Enrique Gongora .

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Editors and Affiliations

  1. University of Pittsburgh Medical Center, Presbyterian Hospital, Clinical Assistant Professor, Pittsburgh, 15213-2582, Pennsylvania, USA

    Kathirvel Subramaniam

  2. Physician Director of Perioperative Serv, Professor of Clinical Anesthesia and of, Associate Vice President, Columbus, 43210, Ohio, USA

    Kyung W. Park

  3. Harvard Medical School, Director, Division of Cardiovascular Ane, Assistant Professor in Anesthesia, Boston, 02215, Massachusetts, USA

    Balachundhar Subramaniam

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Gongora, E., Gleason, T.G. (2011). Operative Techniques in Surgery of the Proximal Thoracic Aorta and Aortic Arch. In: Subramaniam, K., Park, K., Subramaniam, B. (eds) Anesthesia and Perioperative Care for Aortic Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-85922-4_5

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