Aortic Arch Replacement With a Trifurcated Graft

Abstract

The critical consideration in approaching aortic arch surgery is how best to protect the brain while providing surgical access to the cerebral vessels. Between 1999 and 2016, 285 patients underwent aortic arch replacement using the trifurcated graft technique, with 7.4% mortality (hospital/30 day). Neurologic outcomes included 5.1% temporary neurologic deficits, 3.9% permanent neurologic deficits and no spinal cord injury. The trifurcated graft technique addresses the two most important aspects of cerebral protection: minimizing cerebral ischemia and preventing cerebral embolization of air and atheromatous debris. In practice, the technique has proven to be technically straightforward and versatile, in that it is readily adapted to a variety of arch anomalies and pathologies.