Left Thoracotomy HeartWare Implantation With Outflow Graft Anastomosis to the Descending Aorta

An 83-year-old male with a history of three prior sternotomies, including coronary artery bypass surgery (CABG), presented with unstable angina. Cardiac catheterization showed left main and triple-vessel disease. The saphenous vein graft (SVG) to the right coronary artery was diseased but patent, and the SVG to the left anterior descending artery (LAD) was occluded. Preoperative evaluation showed a heavily calcified ascending aorta and minimum disease on the descending aorta. He successfully underwent a left thoracotomy 2-vessel off-pump CABG using the descending aorta for the proximal anastomosis. The left thoracotomy approach is a useful alternative to avoid complications associated with resternotomy, especially in patients with a hostile chest, although visualization of the target vessels may be limited.

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Design Concepts and Preclinical Results of a Miniaturized HeartWare Platform: The MVAD System

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000155 ◽

2015 ◽

Vol 10 (3) ◽

pp. 151-156 ◽

Cited By ~ 22

Author(s):

Anson Cheung ◽

Katherine Chorpenning ◽

Daniel Tamez ◽

Charles Shambaugh ◽

Anne E. Dierlam ◽

...

Keyword(s):

Thrombus Formation ◽

Blood Chemistry ◽

Left Ventricular ◽

Original Design ◽

Ventricular Assist ◽

Pump Design ◽

Descending Aorta ◽

Design Concepts ◽

Implantation Techniques ◽

Outflow Graft

Objective Ventricular assist device (VAD) miniaturization is one design trend that may result in less-invasive implantation techniques and more versatility with patient selection. The MVAD System is a miniature, continuous-flow device implanted in the ventricle. The pump is capable of delivering between 0 and 7 L/min of flow at a mean arterial pressure of 75 mm Hg. The impeller was optimized from its original design to improve hydraulic performance, minimize shear regions, and enhance the impeller's radial stiffness. These studies evaluated the MVAD System with modified impeller in the preclinical setting. Methods This modified pump design was tested through chronic studies (n = 6) in a healthy ovine model where 4 animals were implanted for a duration of 30 ± 5 days and 2 animals were implanted for a duration of 90 ± 5 days. The pump was placed in the left ventricular apex with the outflow graft anastomosed to the descending aorta. Postoperatively, no anticoagulant or antiplatelet therapies were administered throughout the study duration. Results All 6 animals reached their elective date of kill, demonstrating no evidence of organ compromise or device-related complications. Average pump parameters did not deviate significantly, and average rotational speed, pump flow, and power consumption were 14095 ± 139 RPM, 4.1 ± 0.4 L/min, and 4.3 ± 0.1 W, respectively. Examination of pump components postexplant demonstrated no mechanical wear or thrombus formation. Conclusions Hemocompatibility and biocompatibility of the modified MVAD System were demonstrated through pump parameters, blood chemistry panels, and histopathology analysis.

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Transapical cannulation for surgical repair of chronic type B aortic dissection

10.22541/au.163889884.43608042/v1 ◽

2021 ◽

Author(s):

Shinsuke Kotani ◽

Minoru Tabata

Keyword(s):

Aortic Dissection ◽

Circulatory Arrest ◽

Cerebrovascular Event ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Descending Aorta ◽

Left Thoracotomy ◽

Cerebrovascular Complications ◽

Bloodless Field

Open surgery for chronic type B aortic dissection has been shown to have considerable risks of cerebrovascular complications. Because retrograde perfusion is a potential cause of intraoperative cerebrovascular events, we report our transapical cannulation strategy for descending aorta replacement in chronic type B aortic dissection repair with circulatory arrest. This technique provides an easy and quick establishment of cardiopulmonary bypass by way of a left thoracotomy, and prevention of cerebrovascular event. Transapical cannula can be also used as a vent to ensure a bloodless field during proximal anastomosis and to prevent extension of left ventricle during rewarming. Transapical cannulation is a useful option in open repair of the descending aorta for chronic type B aortic dissection by way of left thoracotomy.

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Descending Aorta Finger Clamping to Control Intra-Abdominal Bleeding Due to Rupture of Anterior Superior Pancreaticoduodenal Artery Aneurysm

Surgical Case Reports ◽

10.31487/j.scr.2020.05.03 ◽

2020 ◽

pp. 1-4

Author(s):

Nobuyuki Takemura ◽

Fuminori Mihara ◽

Hayato Ono ◽

Hitomi Wake ◽

Kaito Yano ◽

...

Keyword(s):

Blood Pressure ◽

Artery Aneurysm ◽

Pancreaticoduodenal Artery ◽

Descending Aorta ◽

Left Thoracotomy ◽

Emergency Situations ◽

Abdominal Bleeding ◽

Severe Hypotension ◽

General Surgeons ◽

Pancreaticoduodenal Artery Aneurysm

Background: Open aortic cross-clamping via a resuscitative left thoracotomy is effective in maintaining adequate blood pressure in patients with abdominal bleeding until achieving hemostasis. However, the procedure to encircle the descending aorta to secure cross-clamping is technically demanding for general surgeons, especially in emergency situations. Case Presentation: We report a case of rupture of the anterior superior pancreaticoduodenal artery aneurysm associated with median arcuate ligament syndrome, which required surgical hemostasis. Because of severe hypotension after laparotomy, open aortic cross-clamping with a left thoracotomy was performed by general surgeons. However, the aortic clamps repeatedly slipped off because the clamping was conducted without encircling the aorta. Then, we attempted finger clamping of the descending aorta, and the blood pressure was quite effectively stabilized. Conclusion: Descending aorta finger clamping via a resuscitative left thoracotomy is easy and feasible and might be an effective procedure to maintain adequate blood pressure for general surgeons.

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