The first successful graft replacement of the aortic arch was reported in 1957. Over the past 50 years, advances in imaging technology, anesthetic management, extracorporeal circulation, surgical technique, and perioperative care have culminated in an armamentarium that now makes it possible to safely repair the aortic arch in the majority of patients. This armamentarium is the focus of this textbook, which is intended to serve as a comprehensive source of information on the available options for assessing and treating adult patients with aortic arch disease.
Experts recruited from five continents have contributed detailed coverage of the general principles underlying aortic arch surgery, the numerous strategies for operative repair, and the outcomes of surgical treatment. The authors had been encouraged to explain the underlying rationale for the approaches they describe and to discuss the advantages and disadvantages of each technique relative to other available methods.
The book will be a valuable resource for cardiovascular anesthesiologists, perfusionists, neurologists, radiologists, and other healthcare professionals who have a special interest in treating patients with thoracic aortic disease.
The aim of the first part, “General Principles,” is to provide information that is essential to understanding aortic arch surgery, including how these operations have evolved over the past half-century, the anatomic considerations that affect choice of strategy, and the natural history data that are used to support treatment decisions.
In the second part, “Imaging Techniques,” our colleagues describe how each of the four major imaging modalities – aortography, computed tomography, magnetic resonance imaging, and echocardiography – can be used to evaluate patients with aortic arch disease. Each of these modalities has important strengths and limitations and must be considered in the context of institutional variations in availability and reliability. Although the book focuses on surgery congenital cardiovascular disease appear in this section wherever they may facilitate the reader’s understanding of adult disease.
The third part, “Strategies for Intraoperative Management and Neurologic Protection,” is intended to present a detailed approach to anesthetic management and to describe the numerous options for obtaining aortic exposure and for monitoring and protecting the brain during arch repair. The relative merits of each technique are covered in detail.
In the fourth part, “Options for Aortic Repair,” our contributors provide detailed descriptions of several different approaches to aortic arch reconstruction. Parts III and IV comprise a virtual menu of management options that can be used when operating on the aortic arch; how various surgical teams select and apply these options when treating distinct conditions is the focus of the fifth part, “Surgical Treatment of Specific Problems.”
The sixth and final part addresses “Neurological Complications,” the prevention of which has remained a major focus of investigation since the first arch replacement operations were performed more than 50 years ago. The aim of this part is to present our current understanding of the mechanisms, evaluation, and treatment of perioperative stroke and other forms of brain injury.
Part I: General Principles
- Chapter 1: Historical perspective – the evolution of aortic arch surgery
- Chapter 2: Surgical anatomy
- Chapter 3: Natural history: evidence-based indications for operation
- Chapter 4: Aortography
- Chapter 5: Computed tomography
- Chapter 6: Magnetic resonance imaging
- Chapter 7: Echocardiography
- Chapter 8: Anesthetic management
- Chapter 9: Options for exposure: from minimal access to total aortic replacement
- Chapter 10: Monitoring the brain: near-infrared spectroscopy
- Chapter 11: Monitoring the brain: jugular venous oxygen saturation
- Chapter 12: Monitoring the brain: transcranial Doppler
- Chapter 13: Hypothermic circulatory arrest
- Chapter 14: Direct antegrade cerebral perfusion
- Chapter 15: Antegrade cerebral perfusion via the axillary artery
- Chapter 16: Retrograde cerebral perfusion
- Chapter 17: Perfusion strategies for brain protection: rationale for a selective approach
- Chapter 18: Distal anastomosis first: the traditional approach
- Chapter 19: Alternative approaches: the arch- first technique
- Chapter 20: Alternative approaches: the proximal- first technique
- Chapter 21: Alternative approaches: trifurcated graft technique
- Chapter 22: Alternative approaches: intraluminal aortic ring
- Chapter 23: Alternative approaches: endovascular stent-grafts
- Chapter 24: Surgical adhesives
- Chapter 25: Congenital anomalies in adults
- Chapter 26: Acute dissection
- Chapter 27: Chronic dissection
- Chapter 28: Degenerative aneurysms
- Chapter 29: Trauma
- Chapter 30: Atherosclerotic occlusive disease
- Chapter 31: Inflammatory diseases
- Chapter 32: Resection for malignancy
- Chapter 33: Pathophysiology
- Chapter 34: Evaluation and management
- Chapter 35: Outcomes measurement: neuropsychological testing
- Chapter 36: Outcomes measurement: biochemical markers
Book Details
- Hardcover: 400 pages
- Publisher: Wiley-Blackwell; 1 edition
- Language: English
- ISBN-10: 1405133619
- ISBN-13: 978-1405133616
- Product Dimensions: 10.9 x 8.6 x 1 inches