Beating Heart Removal of an Aortic Arch Thrombus Under Total Body Perfusion

Perfusfind S.L.
Artículos Jan 1, 1970 0

Abstract

Floating thrombi of the aortic arch constitute rare yet highly consequential lesions with high embolic risk for which optimal management remains debated. Conventional surgical management typically requires deep hypothermic circulatory arrest and cardioplegic arrest, both associated with considerable morbidity. We present the case of a 44-year-old woman with a mobile aortic arch thrombus that was successfully managed on a beating heart under uninterrupted systemic and visceral perfusion, thereby eliminating physiologic derangement. This case highlights the feasibility of managing selected aortic arch thrombi with a continuous total body, beating heart strategy that may mitigate the morbidity inherent in cardiac and circulatory arrest.
 
Floating thrombi of the aortic arch (FTAA) represent uncommon yet potentially catastrophic clinical entities, conferring substantial risk of systemic embolization, including cerebrovascular events., Management remains controversial, ranging from anticoagulation to open surgical removal, with the latter typically necessitating deep hypothermic circulatory arrest (DHCA) — associated with coagulopathy, systemic inflammatory response, and neurologic sequelae — as well as cardioplegic arrest, which may impair ventricular function.
We describe a case of recurrent cerebrovascular events secondary to a floating aortic arch thrombus that was successfully treated through a comprehensive strategy using total body perfusion, thereby obviating the need for DHCA and cardioplegic arrest.
A 44-year-old woman with an unremarkable medical history presented with left eye vision loss, preceded by recurrent amaurosis fugax episodes. Risk factors included smoking, overweight (body mass index 29.92 kg/m2), and oral contraceptive use.
Computed tomographic angiography demonstrated a thrombus along the inner curvature of the aortic arch, distal to the brachiocephalic artery (BCA) (Figure 1A), and complete left internal carotid artery occlusion. Echocardiography corroborated the presence of a highly mobile mass. The patient was admitted to the intensive care unit and commenced on heparin. Given the thrombus mobility and embolic potential, consensus was reached to proceed with urgent surgical removal.

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