Crawford type II thoracoabdominal aortic aneurysm repair using deep hypothermic circulatory arrest and continuous proximal aortic perfusion

We successfully operated a patient with Crawford type II dissecting thoracoabdominal aortic aneurysm using deep hypothermic circulatory arrest and continuous proximal aortic perfusion. A 70-year-old male who had a history of chronic Stanford type B aortic dissection treated by Y-graft replacement of the abdominal aorta 2 years ago underwent dissecting thoracoabdominal aotic aneurysm repair due to expansion of the aneurysm. A preoperative examination revealed 90% stenosis in his coronary system. We used deep hypothermic circulatory arrest (bladder temperature: 22 degrees C) and continuous proximal aortic perfusion as adjuncts to prevent organ malperfusion (including the coronary arteries) or embolism because sequential aortic clamping seemed impossible and the true lumen became narrowed. To minimize the duration of the extracorporeal circulation (ECC), visceral branches were reattached using a selective shunt after conclusion of ECC. The duration of aortic cross-clamping, ECC, and operation was 170, 302, and 1,020 minutes, respectively. The patient required mechanical ventilation for 12 days but survived the operation and was discharged after 42 days hospitalization without any neurologic sequela. A perioperative intensive treatment must be required to prevent morbidities related to extensive thoracoabdominal aortic aneurysm repair.