Aortic Delamination—A Possible Precursor of Impending Catastrophe

AbstractAortic diameter is a powerful predictor of adverse aortic events, such as aortic rupture or dissection, forming the basis of prophylactic surgical repair criteria. Limited evidence is available regarding the association of aortic wall thickness (AWT) with these adverse aortic events. We present the case and surgical video of a 73-year-old man with chest pain and an increased AWT, who underwent ascending aortic repair and deep hemiarch placement under deep hypothermic circulatory arrest. Surgical pathology demonstrated evidence of aortic delamination and medial separation, indicative of an impending dissection. The patient recovered uneventfully, and his chest pain ultimately resolved after open repair. In this patient, increased AWT was felt to be the precursor to a potential aortic catastrophe.

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A cardiopulmonary bypass strategy to support a patient with vein of Galen malformation

Perfusion ◽

10.1177/02676591211001534 ◽

2021 ◽

pp. 026765912110015

Author(s):

Alex Robertson ◽

Nagarajan Muthialu ◽

Mike Broadhead

Keyword(s):

Cardiopulmonary Bypass ◽

Surgical Repair ◽

Circulatory Arrest ◽

Ductus Arteriosus ◽

Venous Drainage ◽

Deep Hypothermic Circulatory Arrest ◽

Vein Of Galen ◽

Vein Of Galen Malformation ◽

Neurological Sequelae ◽

Ph Stat

We present a dissection of the patent ductus arteriosus and pulmonary artery for surgical repair utilising cardiopulmonary bypass in the setting of vein of Galen malformation. Several strategies were employed to attenuate the cerebral shunt including pH-stat, high cardiac index, restrictive venous drainage, continuous ventilation and deep hypothermic circulatory arrest. The patient recovered from surgery with no apparent neurological sequelae.

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Hypoxemic reperfusion exacerbates the neurological injury sustained during neonatal deep hypothermic circulatory arrest: a model of cyanotic surgical repair☆

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2007.01.006 ◽

2007 ◽

Vol 31 (5) ◽

pp. 906-914 ◽

Cited By ~ 7

Author(s):

Edward J. Hickey ◽

Xiaomang You ◽

Vassil Kaimaktchiev ◽

Ross M. Ungerleider

Keyword(s):

Surgical Repair ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Neurological Injury

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Surgical Treatment for Secondary Aortoesophageal Fistula

10.21203/rs.3.rs-34073/v1 ◽

2020 ◽

Author(s):

Kayo Sugiyama ◽

Toru Iwahashi ◽

Nobusato Koizumi ◽

Toshiya Nishibe ◽

Toshiki Fujiyoshi ◽

...

Keyword(s):

Aortic Wall ◽

Surgical Repair ◽

Open Repair ◽

Rare Condition ◽

Thoracic Endovascular Aortic Repair ◽

Aortic Aneurysms ◽

Total Arch Replacement ◽

Aortoesophageal Fistula ◽

Open Surgical Repair ◽

Long Period

Abstract BackgroundAortoesophageal fistula(AEF) is a relatively rare condition that is often life-threatening.Secondary AEF is a complication ofprevious surgery,whichcan be more critical and challenging than primary AEF.The number of secondary AEF is increasing due to increase in the number of thoracic endovascular aortic repair (TEVAR). Although TEVAR has become a successful alternative surgical strategy forthoracic aortic aneurysms, secondary AEF after TEVAR might be critical than other secondary AEF because of severe adhesion between the esophagus and residual thoracic aortic wall.Methods This study analyzedsixpatients with secondaryAEFwho were treated at TokyoMedical University Hospitalbetween 2011 and 2016. These participants includedfour patients who had undergone TEVAR and two who had undergone total arch replacement.ResultsAlthough they were subsequently hospitalized for a long period, open surgical repair was completed intwo patients who had undergonetotal archreplacement.TEVAR alone was performedin two patients who had undergone TEVAR and they were discharged without major complications shortly. Combined repair of TEVARas a bridge to open surgery was plannedfor two patients who had undergone TEVAR. However, reconstruction of the aorta and esophagus could not be completed in these patients due to severe adhesions, and they died during hospitalization. ConclusionsDefinitive open repair wassuccessfully performed in patients with secondary AEF after total arch replacement. However, in the patients with secondaryAEF after TEVAR, severe adhesion between the aorta and esophagus led to difficulty in performing a successful definitive open repair.The strategy for secondary AEF should, therefore, be decided considering the etiology of secondary AEF. In secondary AEF after TEVAR, palliative treatment using TEVAR without reconstruction of aorta and esophagus should be considered.

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Myocardial performance and hemodynamics after cardiopulmonary bypass and deep hypothermic circulatory arrest in neonatal piglets

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0029-1191530 ◽

2009 ◽

Vol 56 (S 01) ◽

Author(s):

T Tirilomis ◽

L Nolte ◽

OJ Liakopoulos ◽

K Steinke ◽

M Bensch ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Myocardial Performance ◽

Neonatal Piglets

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Defining the margin of safety of deep hypothermic circulatory arrest with various brain protective strategies

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2006-925768 ◽

2006 ◽

Vol 54 (S 1) ◽

Author(s):

L Ben Mime ◽

S Arnhold ◽

J Fischer ◽

R Raji ◽

U Mehlhorn ◽

...

Keyword(s):

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Margin Of Safety ◽

Protective Strategies

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Open Distal Anastomosis Technique for Ascending Aortic Aneurysm Repair without Cerebral Perfusion

The Heart Surgery Forum ◽

10.1532/hsf.1284 ◽

2015 ◽

Vol 18 (4) ◽

pp. 124

Author(s):

Mehmet Kaplan ◽

Bahar Temur ◽

Tolga Can ◽

Gunseli Abay ◽

Adlan Olsun ◽

...

Keyword(s):

Aortic Aneurysm ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Distal Anastomosis ◽

Ascending Aortic Aneurysm ◽

Aortic Aneurysm Surgery ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Background: This study aimed to report the outcomes of patients who underwent proximal thoracic aortic aneurysm surgery with open distal anastomosis technique but without cerebral perfusion, instead under deep hypothermic circulatory arrest.Methods: Thirty patients (21 male, 9 female) who underwent ascending aortic aneurysm repair with open distal anastomosis technique were included. The average age was 60.2±11.7 years. Operations were performed under deep hypothermic circulatory arrest and the cannulation for cardiopulmonary bypass was first done over the aneurysmatic segment and then moved over the graft. Intraoperative and early postoperative mortality and morbidity outcomes were reported.Results: Average duration of cardiopulmonary bypass and cross-clamps were 210.8±43 and 154.9±35.4 minutes, respectively. Average duration of total circulatory arrest was 25.2±2.4 minutes. There was one hospital death (3.3%) due to chronic obstructive pulmonary disease at postoperative day 22. No neurological dysfunction was observed during the postoperative period.Conclusion: These results demonstrate that open distal anastomosis under less than 30 minutes of deep hypothermic circulatory arrest without antegrade or retrograde cerebral perfusion and cannulation of the aneurysmatic segment is a safe and reliable procedure in patients undergoing proximal thoracic aortic aneurysm surgery.

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