Post-Operative Management of Interrupted Aortic Arch Repair

Immediate Post-Operative Care

The European Society of Cardiology recommends invasive monitoring with arterial line and continuous ECG recording in an intensive care unit setting for patients after interrupted aortic arch repair 1
Strict blood pressure control with target <140/90 mmHg using intravenous anti-impulse therapy initially, then transitioning to oral beta-blockers after 24 hours if gastrointestinal function is preserved, as recommended by the European Society of Cardiology 1, 2
If beta-blockers are contraindicated, non-dihydropyridine calcium channel blockers should be considered, according to the European Society of Cardiology 2

Regular neurological assessments to detect potential complications from cerebral hypoperfusion during surgery, particularly if deep hypothermic circulatory arrest was used, are recommended by the American Heart Association 3, 4
For patients who had lumbar drains placed during surgery, maintaining CSF pressure around 10 mmHg with hourly checks is advised by the American Heart Association 4
Immediately clamping lumbar drain and notifying surgical team if any change in level of consciousness, irritability, confusion, headache, or pupillary reactivity occurs, as recommended by the American Heart Association 4

Optimizing ventilator settings to maintain adequate oxygenation while minimizing barotrauma is recommended by the American Heart Association 4
Implementing pulmonary physiotherapy and incentive spirometry after extubation is advised by the American Heart Association 4

Careful fluid balance management to avoid volume overload or depletion is recommended by the American Heart Association 4
Monitoring and correcting coagulation parameters, particularly if deep hypothermia was used during surgery, is advised by the American Heart Association 4
Being vigilant for heparin-induced thrombocytopenia, which can lead to thromboembolic events, is recommended by the American Heart Association 4

For open repair of thoracic aortic aneurysm, an early CT scan within 1 month is recommended by the European Society of Cardiology 5
For patients who underwent TEVAR, surveillance imaging is recommended at 1, 6, and 12 months, then yearly, as advised by the European Society of Cardiology 6
After open repair of thoracic aortic aneurysm, yearly CT follow-up for the first 2 post-operative years, then every 5 years if findings remain stable, is recommended by the European Society of Cardiology 5

Monitoring for signs of organ malperfusion (cerebral, mesenteric, renal, or limb) which may require immediate intervention is recommended by the European Society of Cardiology 2
For patients with mesenteric malperfusion, considering angiographic evaluation and potential endovascular intervention is advised by the European Society of Cardiology 1

Recommending avoidance of strenuous lifting, pushing, or straining that would require a Valsalva maneuver is advised by the American Heart Association 4
Providing clear lifestyle goals to improve long-term health outcomes is recommended by the American Heart Association 4
Emphasizing the importance of continuing antihypertensive medications to maintain blood pressure control is advised by the American Heart Association 4
For patients who underwent valve-sparing aortic surgery, considering low-dose aspirin (75-100 mg/day) for the first 3 months if there are no other indications for oral anticoagulation is recommended by the European Society of Cardiology 5