Name of the Procedure:

Transverse Arch Graft with Cardiopulmonary Bypass (CPB)

Summary

A transverse arch graft with cardiopulmonary bypass is a surgical procedure where a section of the aortic arch is replaced or repaired using a graft while the heart and lungs are temporarily bypassed by a machine that takes over their functions.

Purpose

This procedure addresses aneurysms, dissections, or blockages in the transverse aortic arch. The aim is to restore normal blood flow and prevent rupture, thereby reducing the risk of catastrophic cardiovascular events.

Indications

• Aortic aneurysm
• Aortic dissection
• Severe atherosclerosis in the aortic arch
• Traumatic injury to the aortic arch Patients generally need to be in good overall health aside from their aortic disease, and the procedure is more common in patients with life-threatening conditions that cannot be managed by less invasive treatments.

Preparation

• Fasting for 8-12 hours before surgery
• Stopping certain medications as advised by the doctor
• Undergoing diagnostic tests including blood tests, echocardiogram, CT scan, or MRI Patients will typically meet with their surgical team and anesthesia team prior to surgery for last-minute instructions and questions.

Procedure Description

1. The patient is placed under general anesthesia.
2. A median sternotomy (incision down the center of the chest) is performed.
3. The patient is connected to a cardiopulmonary bypass machine, which takes over the functions of the heart and lungs.
4. The surgeon identifies the section of the aortic arch that needs repair or replacement.
5. The compromised section of the aorta is removed and replaced with an artificial graft.
6. The graft is sewn into place, ensuring the continuity of blood flow.
7. The patient is weaned off the cardiopulmonary bypass machine, and the heart and lung functions are restored.
8. The incision is closed, and the patient is moved to the Intensive Care Unit (ICU) for monitoring.

Duration

The procedure typically takes 4-6 hours.

Setting

Performed in the operating room of a hospital.

Personnel

• Cardiothoracic surgeon
• Surgical assistants
• Anesthesiologist
• Perfusionist (operates the cardiopulmonary bypass machine)
• Operating room nurses

Risks and Complications

• Bleeding
• Infection
• Stroke
• Heart attack
• Kidney failure
• Complications from anesthesia
• Issues related to the graft, such as clots or leaks

Benefits

• Alleviates symptoms related to the aortic condition
• Reduces the risk of aortic rupture or other life-threatening cardiovascular events
• Improved quality of life and potentially increased lifespan

Recovery

• Patients typically spend 1-2 days in the ICU followed by several days in a regular hospital room.
• Recovery at home includes restricted activities and gradual return to normal.
• Follow-up appointments are necessary to monitor the patient’s recovery and the functionality of the graft.
• Full recovery may take several weeks to months depending on individual health factors.

Alternatives

• Medications to manage symptoms (less effective for severe cases)
• Endovascular repair (less invasive but not suitable for all cases)
• Regular monitoring if the condition is not immediately life-threatening Each alternative carries its own risks and benefits and may not provide the same level of definitive repair as the transverse arch graft procedure.

Patient Experience

During the procedure, the patient is under general anesthesia and feels no pain. Post-procedure, patients may experience pain at the incision site, fatigue, and a period of limited physical activity. Pain can be managed with medications, and comfort measures are taken by the healthcare team to ensure a smooth recovery.