IMMEDIATE RESULTS OF USING A NEW X-GRAFT FOR ANTEGRADE CEREBRAL PERFUSION AND AORTIC RACH BRANCHES RECONSTRUCTION DURING TOTAL ARCH REPLACEMENT

Highlights

Several studies have demonstrated the advantage of using the branch-first technique for aortic arch branch replacement in terms of reduced mortality and neurological complications. The unavailability and high cost of the multi-branch graft used for the branch-first technique has prompted the search for and development of new grafts, such as the X-graft. Both types of multi-branch grafts have demonstrated comparable results in terms of the incidence of neurological deficit, mortality, significant postoperative complications, and angiographic patency. Furthermore, the X-graft has the advantage of reduced fabrication time, which may be important in emergency situations.

Background. The optimal method for aortic arch branches reimplantation during total aortic arch replacement remains a matter of debate, as the incidence of neurological complications is quite high.

Aim. To present a new multi-branch X-graft and compare its clinical outcomes with a standard multi-branch graft.

Methods. This retrospective, single-center study included 153 patients with aortic arch pathology who underwent total aortic arch replacement and all its branches from January 2019 to February 2026. Of these, 88 patients underwent aortic arch replacement using a prefabricated 12 × 10 × 8 × 8 TAPP graft or its equivalent, formed from individual linear grafts (TAPP group). A new X-graft formed from two linear grafts was used for this purpose in 65 patients (X-graft group). The primary endpoint was neurological deficit. Secondary endpoints included in-hospital mortality, significant postoperative complications, and patency of the multibranch graft branches. Regression analysis was performed to identify predictors of neurological dysfunction.

Results. The incidence of permanent neurological deficits was higher in the TAPP group, but the differences were not statistically significant (6.8% vs. 3.1%, p = 0.468). In-hospital mortality was 5.7% in the TAPP group and 9.2% in the X-graft group (p = 0.529). Significant postoperative complications did not differ between the groups. The X-graft group had a lower need for red blood cell transfusions (p = 0.004). Stenosis greater than 50% or branch occlusion of the multi-branch graft were detected in three patients in the TAPP group (3.4%) and two patients in the X-graft group (3.1%). An independent predictor of permanent neurological deficit was cerebral malperfusion (OR 11.658, p = 0.005).

Conclusion. The new X-graft for antegrade cerebral perfusion and supra-aortic branch replacement in aortic arch surgery is comparable in clinical efficacy and angiographic patency to the standard four-branch graft. In the absence of a prefabricated TAPP graft, the X-graft has an advantage in formation speed compared to an intraoperatively fabricated TAPP graft analogue.

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