Direct cannulation of the common carotid artery during the ascending aortic or aortic arch replacement

Objective: To evaluate cerebral perfusion using direct cannulation into the common carotid artery. A new technique is needed to protect brain ischemic injury during ascending aortic or aortic arch replacement. Methods: This technique was evaluated for patients who would have difficulty maintaining adequate cerebral perfusion during surgery. The procedure was performed when patients had the following diagnoses: pseudoaneurysm formation in contact with the sternum with the risk of aneurysmal rupture (n=5), acute aortic dissection with compression of the true lumen of the innominate artery by the pseudolumen (n=3), or a large volume of thrombus in the lumen of the aneurysm with the risk of cerebral thromboembolism if standard extracorporeal circulation was used (n=2). The perfusion catheter was cannulated into one side of the common carotid artery (right side: n=6, left side: n=4) and mean perfusion flow rate was found to be 175 mL/min. The operative procedures consisted of ascending aortic and aortic arch replacement with coronary artery bypass grafting in six patients, ascending aortic replacement in 2 patients, and innominate artery reconstruction/innominate artery and right subclavian artery reconstruction in one patient. Results: No cerebral accidents or deaths occurred while patients were hospitalized. We have followed up patients for a mean of 2.1 years (maximum 3.6 years), with no complications noted from the surgical procedure. Conclusions: Direct cannulation of the common carotid artery is a simple, safe, and acceptable cerebral protection for patients undergoing aortic or aortic arch replacement procedures in the patients with these specific conditions.     

Occlusion of the abdominal aorta caused by enlargement of the false lumen after graft replacement for a DeBakey type IIIb dissecting aneurysm: Report of a case

(Received for publication on July 10, 1997; accepted on Mar. 10, 1998)     

升主动脉和弓部动脉瘤的外科治疗

目的：总结升主动脉和弓部动脉瘤手术治疗经验，以期进一步提高手术疗效。方法：自2000年7月至2002年5月应用深低温停循环（DHCA）和上腔静脉逆行脑灌注（RCP）技术手术治疗升主动脉和弓部动脉瘤20例，其中急症手术5例。施行全弓置换术2例，全弓置换和象鼻手术3例，半弓置换术15例。同期行Bentall手术8例，升主动脉置换术或同时行主动脉瓣置换术12例，冠状动脉旁路移植术1例。结果：术后早期死亡1例，短时间浅昏迷1例，呼吸功能不全2例，肾功能不全2例，无晚期死亡。结论：DHCA和RCP技术是手术治疗升主动脉和弓部瘤的安全、有效方法，急性A型夹层动脉瘤的手术方式取决于内膜破裂口的位置；正确掌握DHCA和RCP技术，手术方式和手术技术、围术期处理是提高手术疗效的关键因素。     

Penetration by a huge abdominal aortic aneurysm into the lumbar vertebrae: Report of a case

(Received for publication on Oct. 5, 1998; accepted on May 27, 1999)     

Ruptured giant aneurysm of the ascending aorta caused by chronic aortic dissection

A 55-year-old man developed acute chest pain and dyspnea. Computed tomography demonstrated a rupture of a giant aneurysm of the ascending aorta. The lesion was 14 cm in diameter—the largest ever reported—and resulted from chronic aortic dissection. The patient did not have aortic insufficiency or aortic dissection around the coronary ostium. Graft replacement of the ascending aorta was performed successfully under deep hypothermia with right hemisphere perfusion.     

Successful surgical treatment of an Edwards type IIIB right aortic arch aneurysm: Report of a case

(Received for publication on May 12, 1997; accepted on Jan. 6, 1998)     

Long-term outcomes of total arch replacement using a 4-branched graft

Objective

Our study evaluated the long-term outcomes of total arch replacement using a 4-branched graft.

The efficacy of non-clamping selective cerebral perfusion in distal aortic arch aneurysm repair: Report of a case

Successful repair of a distal aortic arch aneurysm without aortic cross-clamping was carried out in a 74-year-old man, using a combination of special separate cerebral perfusion and retrograde coronary perfusion, termed non-clamping selective cerebral perfusion. We believe that satisfactory results following aortic arch surgery in elderly patients can only be achieved through the prevention of emboli derived from an aortic cross-clamping site, and shortened ischemic time of the vital organs.     

Repeat surgery for hemolysis 6 years after replacement of the ascending aorta for acute aortic dissection

A 71-year-old woman underwent replacement of the ascending aorta for Type A aortic dissection. After 6 years, she suddenly developed severe hemolytic anemia, and a second operation for replacement of the ascending aorta was performed. Her hemolysis was thought to occur as follows: the proximal ascending aorta of the graft might have gradually expanded until it compressed the graft. The severe hemolysis was thought to be attributable to disturbance of blood flow by a jet of blood at the site of constriction or the reversed inner felt. Such a case as this is very unusual in that the second operation for hemolytic anemia occurred 6 years after the first surgery.     

Successful graft replacement of the descending aorta after an extended reconstruction of the ascending and transverse aorta in a patient with marfan’s syndrome

(Received for publication on Jan. 14, 1997; accepted on Sept. 2, 1997)     

Urgent total arch graft replacement in an elderly patient with acute type a dissection: Report of a case

(Received for publication on July 8, 1996; accepted on Mar. 4, 1997)     

Spontaneous peripelvic extravasation of urine due to an inflammatory aneurysm of the abdominal aorta

A 71-year-old man presented complaining of severe left flank pain. A computed tomography scan of the abdomen disclosed a left peripelvic extravasation of urine and a 4.0-cm abdominal aortic aneurysm with a significant amount of perianeurysmal thickening and prominent left hydroureter. The patient was diagnosed as having an inflammatory aneurysm of the abdominal aorta (IAAA) with peripelvic extravasations of urine. We report the results of a patient with IAAA with ureteral obstruction successfully treated with steroid therapy and a ureteral stent.     

Hydatid cyst of the abdominal aorta and common iliac arteries complicated by a false aneurysm: a case report

The rupture of hydatid cysts into the abdominal aorta is an unusual and serious complication of the hydatid disease. The authors describe a case of a 12-year-old girl with hydatid disease presenting as a retroperitoneal mass invading the wall of the abdominal aortic bifurcation and complicated by a false aneurysm. Difficulties of preoperative diagnosis and operative management were discussed, and the literature was reviewed.     

Antegrade selective cerebral perfusion during surgery of the thoracic aorta: risk analysis

Objective: To determine independent predictors of neurologic outcome and hospital mortality after surgery of the thoracic aorta using moderate hypothermic circulatory arrest and antegrade selective cerebral perfusion. Methods: Between November 1996 and June 2000, 96 consecutive patients (69 men, 27 women; mean age 63±10 years) underwent operations on the thoracic aorta with the aid of moderate hypothermic circulatory arrest and antegrade selective cerebral perfusion. Sixty-four patients were operated on electively (66.7%), 32 emergently (33.3%). Indications for surgery were: type A acute dissection in 30 patients (31.3%), chronic aneurysm in 66 (68.8%). Seventeen patients (17.7%) had undergone previous aortic/cardiac surgical procedures. The mean selective cerebral perfusion time was 52.2±31.9 min (range, 18–220 min). Preoperative, intraoperative, and postoperative factors were analyzed by univariate and multivariate analysis to identify predictors of hospital mortality and neurologic outcome. Results: There were no operative deaths; the hospital mortality rate was 11.5% (11/96). Stepwise logistic regression revealed preoperative renal dysfunction (P=0.021), type A acute dissection (P=0.053), coronary artery bypass grafting (P=0.058), post-operative pulmonary complications (P=0.000) and repeat thoracotomy for bleeding (P=0.027) as independent predictors of hospital mortality. One patient sustained a permanent neurologic deficit (1%). Transient neurologic deficit occurred in eight patients (8.3%). Coronary artery bypass grafting (P=0.013), and postoperative cardiac complications (P=0.049) were statistically associated with an increased risk of any (transient and permanent) neurologic dysfunction on univariate analysis. Stepwise logistic regression indicated coronary artery bypass grafting as independent factor for any neurologic dysfunction. Conclusion: This study confirmed that selective cerebral perfusion is an effective method of cerebral protection allowing complex thoracic aorta operations to be performed with low risk of hospital mortality and adverse neurologic outcome. We didn't find that the duration of selective cerebral perfusion time influence hospital mortality and any neurologic deficit.     

Percutaneous Insertion of a Jacketed Stent to Close the Entry of Dissecting Aortic Aneurysms of DeBakey Types I and II

Abstract: As a treatment for dissecting aortic aneurysms of DeBakey Types I and II, a percutaneous insertion method using a new jacketed stent was developed. The efficacy of the method was evaluated in an animal study. We developed a special stent prepared by modifying the original Gianturco self-expandable metallic stent and a fabric patch. A model of a dissecting aortic aneurysm of DeBakey Type I was created in dogs. The device was inserted into the ascending aorta from the left carotid artery through a sheath-introducer system. The aortogram showed the bloodstream through the false lumen before the insertion, but no bloodstream after the stent insertion. The autopsy showed that the entry, the reentry, and the false lumen were completely filled with fresh thrombus. By using this stent, we successfully achieved an interventional treatment for dissecting aortic aneurysms of DeBakey Types I and II.     

Open hemiarch versus clamped ascending aorta replacement for aortopathy during initial bicuspid aortic valve replacement

BackgroundThere is controversy regarding the extent of aortic resection necessary in patients with aortopathy related to bicuspid aortic valve disease. To address this issue, we reviewed our experience in patients undergoing ascending aorta replacement during bicuspid aortic valve replacement.MethodsWe reviewed 702 patients who underwent ascending aorta replacement at the time of initial nonemergent native bicuspid aortic valve replacement at our institution between January 2000 and June 2017. Treatment cohorts included an open hemiarch replacement group (n = 225; 32%) and a clamped ascending aorta replacement group (n = 477; 68%).ResultsMedian patient age was 60 years (interquartile range [IQR], 51-67 years), female sex was present in 113 patients (16%), ejection fraction was 62% (IQR, 56%-66%), and aortic arch diameter was 33 mm (IQR, 29-36 mm). Cardiopulmonary bypass time was longer in the hemiarch replacement group (188 minutes vs 97 minutes; P < .001). Procedure-related complications (36%) and mortality (<1%) were similar in the 2 groups; however, the hemiarch group had an increased odds of blood transfusion (odds ratio, 1.62; 95% confidence interval [CI], 1.15-2.28; P = .006). The median duration of follow-up was 6.0 years (95% CI, 5.3-6.8 years). Overall survival was 94 ± 1% at 5 years and 80 ± 2% at 10 years. Multivariable analysis demonstrated similar survival in the 2 groups (hazard ratio, 0.83; 95% CI, 0.51-1.33; P = .439). No repeat aortic arch operations were done for aortopathy over the duration of clinical follow-up.ConclusionsCompared with patients in the clamped ascending aorta replacement group, patients in the hemi-arch replacement group had longer cardiopulmonary bypass and aortic cross-clamp times, along with an increased risk of blood transfusion, but similar freedom from repeat aortic arch operation and survival. We identified no advantage of performing hemiarch replacement in the absence of aortic arch dilation.     

Bicuspidization of the morphological tricuspid aortic valve with ascending aorta replacement in a 5‐year‐old child

Ascending aortic aneurysms are rare in children and may lead to aortic insufficiency, dissection, and/or rupture. We present a 5‐year‐old child diagnosed with an ascending aortic aneurysm and severe aortic insufficiency, successfully treated with ascending aortic replacement with an aortic valve repair using a bicuspidation technique.