As a university center, we also offer surgical interventions in the thoracic (thoracic) aorta (main artery) both for interventional surgery, but also in the context of emergency care.

• Flap-Carrying Aortic Conduit (Bio and Artificial Flap)
• Ascending Aorta Replacement after David Procedure Preserving the Aortic Valve
• Aortic Arch Replacement (Partial or Complete)
• Hybrid Method Involving the Descending Aorta (Frozen Elephant Trunk)
• Interventional-Surgical Combination Interventions (Interdisciplinary)

In the past, the systemic circulation had to be temporarily stopped during the operation of the aortic arch. The operation was performed in cardiac arrest. In order to prevent damage to the organs - especially the brain - the patient was cooled using the heart-lung machine. It was customary to cool to a body temperature of 18 - 20 ° C. This allowed a time of 30 - 45 minute window to perform the procedure on the aortic arch without permanent damage to the organs. Unfortunately, the side effects such as coagulation disorders and the risk of stroke were significantly increased.

Our Current Technology:

Brain Protection by Antegrade Brain Perfusion during Cardiac Arrest

Great progress has been made in recent years in the surgery of the aortic arch. Through special catheters, the brain can be supplied with blood during the entire operation on the aortic arch (antegrade brain perfusion), which only necessitates a cooling of the body temperature (to approx. 28 ° C). This significantly shortens the duration of the operation, has a positive influence in lessening the blood loss after the operation and shortens the intensive care stay of the patients. The risk of stroke can be significantly reduced with this technique.

David Operation (reconstruction of the aortic valve in an aortic aneurysm or an aortic dissection (type A) with Aortic Valve Insufficiency):

If an aortic aneurysm or an aortic dissection secondary to the dilation of the valve ring causes aortic insufficiency, the aortic valve can be reconstructed. We don’t always have to replace the aortic valve.

In this operation, named after the cardiac surgeon Tirone Esperidiao David, the base of the main artery is removed and the native flap is sutured into a made-to-measure vascular prosthesis so that the edges of the flap pockets can meet again. The openings of the coronary arteries are cut together with a patch from the aorta and later integrated into the new prosthesis, so that the blood circulation of the heart is restored.

Since the aortic valve is preserved, no anticoagulant is required after this operation.

Elephant Trunk Technology

Patients with an aneurysm involving both the ascending aorta, the aortic arch and the descending aorta remain a major challenge for any surgeon. The main concern is the perfusion of the brain and spinal cord, but of course all other organs. For brain protection, we perform antegrade brain perfusion and intensive neuromonitoring.

To replace the aortic arch, the Elephant Trunk technique was introduced in 1983 by Hans Borst. In this case, a prosthesis is sewn into the ascending aorta and into the arch via a median sternotomy, which extends into the descending aorta like an elephant's trunk.

In a second operation, usually after several months, a lateral thoracotomy of the descending aorta is performed.

Hybrid Method (Frozen-Elephant-Trunk Technique)

This technique was developed in Hanover in 2003 and requires only one operation for the simultaneous treatment of an extensive aneurysm of the aortic arch that extends into the descending aorta. The hybrid prosthesis used consists of two parts: a stent is introduced into the descending aorta and deployed there. The stent framework transitions directly into a vascular prosthesis adapted to the needs of the complex anatomy of the aortic arch with all its pathways. The pathways of the arm and head arteries are therefore already connected. This vascular prosthesis is implanted in the arch and ascending aorta, and the branches of the prosthesis are sutured to the corresponding brachial and cerebral arteries (left carotid artery, left subclavian artery, and brachiocephalic trunk). The combined approach avoids the risk associated with a follow-up operation.