Aortic Hemiarch Repair Without Circulatory Arrest by Dual Arterial Cannulation: A Case Series

All articles of this category (opens in new window) Background: Aortic surgery, including the proximal aortic arch for aneurysm repair, regularly requires open anastomosis with hypothermic circulatory arrest (HCA) and cerebral perfusion. However, it carries a risk of visceral ischemia and cerebral malperfusion, as well as distinctly increases the technical complexity of the procedure. Methods: All patients undergoing elective proximal arch surgery for aneurysm repair between August 2024 and July 2025 were retrospectively reviewed. A total of n = 7 patients who were operated on without HCA were identified and further analyzed. The extracorporeal circuit of the heart-lung machine was cannulated via the right subclavian artery for the right-sided cerebral perfusion and additionally via either one of the femoral arteries or the left subclavian artery for the left-sided cerebral perfusion and the remaining body. During cardioplegic arrest, both the proximal aortic arch in zone 1 as well as the brachiocephalic trunk were individually cross-clamped, and the extracorporeal perfusion was continued without interruption. Results: The median age of the patients was 62 years [min; max: 38; 81 years] with n = 4 (57.1%) females. Operative procedures included ascending aorta as well as hemiarch replacement with a Dacron graft in all patients (distal anastomosis in zone 0: n = 5, zone 1: n = 2) as well as aortic valve ( n = 5) or root surgery ( n = 2). The median cross-clamp time was 115 minutes [78; 147 minutes] and the median minimal body temperature 34°C [26; 36°C]. All but one patient (85.7%) were extubated on the day of surgery with a median stay at the intensive care unit of 1 day [1; 5 days] and a total postoperative hospital stay of 15 days [7; 19 days]. No patient required postoperative hemodialysis, reinterventions, or suffered from bleeding complications. However, one patient developed a thrombotic cerebellar infarction (maximum NIHSS = 2) on the sixth postoperative day while being on the regular ward, most likely related to the mechanical aortic valve. All patients were successfully discharged and alive in good condition after a maximum follow-up of 225 days. Conclusion: By using biatrial cannulation and clamping, aortic hemiarch surgery is feasible without HCA and relevant hypothermia. Although the cohort is still small, we were able to report excellent results with only one patient suffering from adverse postoperative events, which were most likely not related to the presented operation technique itself. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany