Successful Ascending Aorta and Hemiarch Replacement and Aortic Valve Resuspension Via Redo Median Sternotomy Using Hypothermic Circulatory Arrest in a Practicing Jehovah's Witnesses Patient

2019 ◽  
Vol 33 (5) ◽  
pp. 1447-1454
Author(s):  
John F. Gamble ◽  
Cory D. Maxwell ◽  
Jeffrey Gaca ◽  
Nicole R. Guinn ◽  
Brian C. Cho ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Circulatory Arrest ◽  
Median Sternotomy ◽  
Ascending Aorta ◽  
Hypothermic Circulatory Arrest ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Hemiarch Replacement

Evaluating Operative Techniques for Distal Aortic Arch Reconstruction

1996 ◽  
Vol 4 (1) ◽  
pp. 33-36
Author(s):  
Hiroshi Yoshizu ◽  
Nobuo Hatori ◽  
Yoshiyuki Haga ◽  
Masafumi Shimizu ◽  
Daisuke Segawa ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Circulatory Arrest ◽  
Median Sternotomy ◽  
Ascending Aorta ◽  
Hypothermic Circulatory Arrest ◽  
Posterolateral Thoracotomy ◽  
Artery Cannulation ◽  
Group Iii ◽  
Cerebrovascular Complications ◽  
Group Ii

Twenty-three cases of aortic arch aneurysm, over the past 10 years, were divided into 3 groups of similar age and sex for comparison of operative technique. The aortic arch was reconstructed under normothermic femoral bypass via left posterolateral thoracotomy in 9 patients (group II), under hypothermic circulatory arrest via left posterolateral thoracotomy in 7patients (group II) and under hypothermic circulatory arrest with ascending aorta cannulation and brief retrograde systemic perfusion immediately after finishing reconstruction of the aortic arch via median sternotomy in 7 patients (group III). Surgical mortality in groups I, II and III was 33.3% (3/9), 14.3%(1/7)and14.3%(1/7), respectively. Cerebrovascular complications occurred in 1 of 8 patients (12.5%), excluding an intra-operative death, in group II, and in 4 of 7 cases (57%) in group II, of whom 2 were restored to consciousness. There were no cerebrovascular complications in group III (p< 0.005 v. group II). The patient in group III who died of a lung complication 11 days postoperatively was restored to consciousness. Circulatory arrest time was 30.7 ± 17 and 33 ± 17 minutes in groups II and III, respectively. This study demonstrated that normothermic bypass (group II) resulted in an unsatisfactory surgical outcome, and femoral artery cannulation (group II) caused increased cerebrovascular complications compared with ascending aortic cannulation (group III), suggesting that the retrograde aortic flow, but not circulatory arrest per se, predisposed cerebrovascular morbidity. Vascular embolism by debris could be prevented by normograde perfusion via the ascending aorta and brief retrograde systemic perfusion immediately after finishing reconstruction of the aortic arch.

Pseudoaneurysm of the Ascending Aorta Combined with Aortic Valve Infective Endocarditis following Cardiac Operations

2011 ◽  
Vol 14 (1) ◽  
pp. 70
Author(s):  
Shengli Jiang ◽  
Tao Zhang ◽  
Bojun Li ◽  
Chonglei Rei ◽  
Tingting Chen ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Circulatory Arrest ◽  
Ascending Aorta ◽  
Hypothermic Circulatory Arrest ◽  
Mechanical Prosthesis ◽  
Computed Tomographic ◽  
Life Threatening ◽  
Femorofemoral Bypass ◽  
Cardiac Operations

Background and Objective: Aortic pseudoaneurysms are rare but life-threatening complications of aortic procedures. Operation on the femorofemoral bypass with hypothermic circulatory arrest has been the method of choice. Iatrogenic ascending aorta pseudoaneurysm combined with infective endocarditis of the aortic valve has never been reported.Materials and Methods: We describe a case of a pseudoaneurysm of the ascending aorta at the site of an aortotomy site concomitant with infective endocarditis of the aortic valve. A contrast computed tomographic scan was the investigation technology of choice.Results: The operation was performed on femorofemoral bypass without hypothermic circulatory arrest, which provided safe re-entry and an opportunity to replace the infected aortic valve with a mechanical prosthesis and to repair the aortic defect with a patch.Conclusions: The ascending aorta pseudoaneurysm can be safely operated on with femorofemoral bypass without hypothermic cardiac arrest.

scholarly journals Aortic Arch Replacement without Deep Hypothermic Circulatory Arrest

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Zviad Bakhutashvili ◽  
Lia Janelidze ◽  
Kakhaber Beria ◽  
Simon Matikashvili ◽  
Eduard Limonjiani
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Artery Bypass ◽  
Deep Hypothermic Circulatory Arrest ◽  
Ascending Aorta ◽  
Hypothermic Circulatory Arrest ◽  
Moderate Hypothermia ◽  
Aortic Arch Replacement ◽  
Valve Insufficiency

A 60-year-old man presented with a thoracic aortic aneurysm without rupture accompanied by severe nonrheumatic aortic valve insufficiency and unstable angina. Surgery was performed and included several steps: (1) resection and reconstruction of ascending aorta and aortic arch using a tube graft, (2) replacement of aortic valve using a biological prosthesis, and (3) coronary artery bypass grafting was performed with two distal anastomoses. All of these procedures were performed with total cardiopulmonary bypass without deep hypothermic circulatory arrest under conditions of moderate hypothermia using dual concurrent cannulation of the subclavian and femoral arteries.

Outcomes of Aortic Valve and Concomitant Ascending Aorta Replacement Performed via a Minimally Invasive Right Thoracotomy Approach

2014 ◽  
Vol 9 (5) ◽  
pp. 339-342 ◽  
Author(s):  
Angelo LaPietra ◽  
Orlando Santana ◽  
Andrés M. Pineda ◽  
Christos G. Mihos ◽  
Joseph Lamelas
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Aortic Valve ◽  
Minimally Invasive ◽  
Circulatory Arrest ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Hypothermic Circulatory Arrest ◽  
Left Ventricular Ejection ◽  
Lengths Of Stay

Objective Replacement of the aortic valve with concomitant replacement of the ascending aorta performed via a minimally invasive right anterior thoracotomy approach has not been reported. We evaluated the feasibility and safety of this procedure. Methods We retrospectively reviewed all minimally invasive aortic valve replacements (AVRs) with concomitant replacement of the ascending aorta performed at our institution between January 1, 2012, and December 30, 2012. The operative times, intensive care unit and hospital lengths of stay, postoperative outcomes, as well as mortality were analyzed. Results A total of 20 consecutive patients who underwent minimally invasive AVR with concomitant replacement of the ascending aorta were identified. There were 16 men (80%), with a mean (SD) age of 61 (13) years. The mean (SD) left ventricular ejection fraction was 58% (8%). The aortic valve was bicuspid in 18 patients (80%), with 14 (70%) being stenotic. The median aortic cross-clamp and cardiopulmonary bypass times were 163 [interquartile range (IQR), 141–170] minutes and 291 (IQR, 177–215) minutes, respectively. Hypothermic circulatory arrest was required in 19 patients (95%), with a median hypothermic circulatory arrest time of 35 (IQR, 33–39.5) minutes. The median intensive care unit and hospital lengths of stay were 24 (IQR, 23–41) hours and 5 (IQR, 4–6) days, respectively. There were no strokes, reoperations for bleeding, or conversions to sternotomy. The 30-day mortality was zero. Conclusions Minimally invasive AVR with concomitant replacement of the ascending aorta, via a right anterior thoracotomy approach, can be performed with low morbidity and mortality.

scholarly journals Pseudoaneurysm of Ascending Aorta with Sternal Erosion after Double Valve Replacement—A Case Report

2019 ◽  
Vol 04 (02) ◽  
pp. 092-094
Author(s):  
Ravi Kumar Kathi ◽  
Amaresh Rao Malempati ◽  
Goutham Kollapalli ◽  
Chaitra Krishna Batt ◽  
Sayyad Sohail Tarekh
Keyword(s):  
Rare Complication ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Muscle Flap ◽  
Ascending Aorta ◽  
Hypothermic Circulatory Arrest ◽  
Chronic Hypertension ◽  
Pulsatile Mass ◽  
Fatal Hemorrhage ◽  
Femorofemoral Bypass

AbstractPseudoaneurysm of ascending aorta is a rare complication after aortic surgery. Predisposing factors can be infection, chronic hypertension, connective tissue disorders, or dissection. Chest pain, sternal erosion, dysphagia, or stridor can be the modes of presentation. It can also present as a pulsatile mass. Redo sternotomy in a case of pseudoaneurysm of aorta can cause fatal hemorrhage or air embolism. In such a scenario, femorofemoral bypass and hypothermic circulatory arrest help to simplify the approach to the pseudoaneurysm. The authors present a case of a 23-year-old female with pseudoaneurysm of the ascending aorta causing sternal erosion. Ascending aortic repair was done using Dacron patch with femorofemoral bypass and hypothermic circulatory arrest. Sternum was repaired using pectoralis major muscle flap.

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