Get out of trouble during redo surgery for false aneurysm of the ascending aorta

2019 ◽  
Vol 28 (2) ◽  
pp. 104-107
Author(s):  
Ernesto Greco ◽  
Valeria Santamaria ◽  
Mizar D’Abramo ◽  
Marco Totaro ◽  
Giacomo Frati ◽  
...  
Keyword(s):  
False Aneurysm ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Massive Hemorrhage ◽  
Ascending Aorta ◽  
Redo Surgery ◽  
Aneurysm Surgery ◽  
Profound Hypothermia ◽  
Blood Cardioplegia ◽  
Risk Of Hemorrhage

Postoperative thoracic aortic false aneurysm is a challenging complication of aortic surgery. We describe our surgical approach for an 8-cm thoracic aorta false aneurysm in a 59-year-old woman who had previously undergone aortic surgery. Surgery must be planned carefully because massive hemorrhage during resternotomy is a dreadful complication of postoperative false aneurysm surgery. We decided to start cardiopulmonary bypass before resternotomy and use a ventricular vent from the apex, an endo-vent from the pulmonary artery, and an endo-balloon with antegrade blood cardioplegia. We successfully performed the procedure without profound hypothermia and circulatory arrest and with a low risk of hemorrhage.

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.

scholarly journals INNOMINATE ARTERY CANNULATION FOR PROXIMAL AORTIC SURGERY

2020 ◽  
Author(s):  
Bülent Mert ◽  
kamil boyacıoğlu ◽  
Hakan Sacli ◽  
Berk Özkaynak ◽  
Ibrahim Kara ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Innominate Artery ◽  
Arterial Injury ◽  
Ascending Aorta ◽  
Artery Cannulation ◽  
The Mean ◽  
Antegrade Cerebral Perfusion

Background. The aim of this study was to evaluate the efficacy and safety of innominate artery cannulation strategy with side graft technique in proximal aortic pathologies. Methods. A total of 70 patients underwent innominate artery cannulation with a side graft for surgery on the proximal aorta from 2012 to 2020. There were 46 men and 24 women with an avarage age of 56 ±13 years. The indications of surgery were type A aortic dissection in 17 patients (24.3%), aortic aneurysm in 52 patients (74.3%) and ascending aorta pseudoaneurysm in 1 patient (1.4%). The innominate artery was free of disease in all patients. Hypothermic circulatory arrest with antegrade cerebral perfusion was utilized in 60 patients (85.7%). 3 patients had previous sternotomy (4.2%). The most common surgical procedure was ascending aorta and hemiarch replacement in 34 patients (48.5%). Results. The mean cardiac ischemia and cardiopulmonary bypass times were 116+46 minutes and164+56 minutes, respectively. The mean antegrade cerebral perfusion time was 27+14 minutes. The patients were cooled between 22’C and 30’C during surgery. 30-day mortality rate was 7.1% with 5 patients. 1 patient (1.4%) had stroke, 1 patient (1.4%) had temporary neurologic deficit and 8 patients (11.4%) had confusion and agitation that resolved completely in all cases. There was no local complication or arterial injury was encounterd. Conclusions. Cannulation of the innominate artery with side graft is safe and effective for both cardiopulmonary bypass and antegrade cerebral perfusion. This technique provides excellent neurologic outcomes for proximal aortic surgery.

scholarly journals Circulatory Arrest, Profound Hypothermia and Barbiturate for Giant Cerebral Aneurysm Surgery Case report

1998 ◽  
Vol 35 (4) ◽  
pp. 767
Author(s):  
Soon Pil Kwoun ◽  
Byoung Sang Min ◽  
Jin Ho Bae ◽  
Sang Tae Kim ◽  
Hoon Kang ◽  
...  
Keyword(s):  
Case Report ◽  
Cerebral Aneurysm ◽  
Circulatory Arrest ◽  
Aneurysm Surgery ◽  
Profound Hypothermia ◽  
Giant Cerebral Aneurysm

scholarly journals Rethinking the Paradigm: Modern Approach to Proximal Aortic Reconstruction Demonstrates Excellent Outcomes

2017 ◽  
Vol 20 (3) ◽  
pp. 092 ◽  
Author(s):  
Jonathan M Hemli ◽  
Edward R. R. DeLaney ◽  
Kush R. Dholakia ◽  
Dror Perk ◽  
Nirav C. Patel ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Elective Surgery ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Ascending Aorta ◽  
Aortic Root Replacement ◽  
Aortic Aneurysms ◽  
Moderate Hypothermia ◽  
Modern Approach ◽  
Modern Era

Background: Techniques for aortic surgery continue to evolve. A real-world snapshot of patients undergoing elective surgery for aneurysm in the modern era is helpful to assist in deciding the appropriate timing for intervention. We herein describe our experience with 100 consecutive patients who underwent primary elective surgery for aneurysm of the proximal thoracic aorta over a two-year period at a single institution.Methods: The majority of our patients were male, mean age 61.19 ± 13.33 years. Two patients had Marfan syndrome. Twenty-eight patients had bicuspid aortic valve. Thirty-four patients underwent aortic root replacement utilizing a composite valve/graft conduit; 23 had valve-sparing root replacements. The ascending aorta was replaced in 89 patients; 80 (89.9%) of these included a period of circulatory arrest at moderate hypothermia utilizing unilateral selective antegrade cerebral perfusion.Results: Thirty-day mortality was zero. Perioperative stroke occurred in 2 patients, both of whom completely recovered prior to discharge. No patients required re-exploration for bleeding. One patient developed a sternal wound infection. Fifteen patients required readmission to hospital within thirty days of discharge.Conclusion: Elective surgery for aneurysm of the proximal aorta is safe, reproducible, and is associated with outcomes that are superior to those seen in an acute aortic syndrome. It may be appropriate to offer surgery to younger patients with proximal aortic aneurysms at smaller diameters, even if their aortic dimensions do not yet meet traditional guidelines for surgical intervention.

Sex-Specific Outcome after Ascending Aortic Surgery in Moderate Hypothermic Circulatory Arrest

2019 ◽  
Author(s):  
Christine Friedrich ◽  
Miriam Freundt ◽  
Mohamed Ahmed Salem ◽  
Bernd Panholzer ◽  
Katharina Huenges ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Elective Surgery ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Female Gender ◽  
Gender Disparity ◽  
Ascending Aorta ◽  
Hypothermic Circulatory Arrest ◽  
Short Term Mortality ◽  
Specific Outcome

Abstract Background Historically, female patients had worse outcome undergoing heart surgery. No recent data exist on gender-specific outcome after moderate hypothermic circulatory arrest (MHCA). The aim of this large retrospective analysis was to investigate gender disparity in patients undergoing elective surgery of ascending aorta in MHCA at 24°C. Methods We conducted a retrospective review of 905 (33.3% female) cases of elective heart surgery in MHCA for ascending aortic aneurysm (90.9%) or severely calcified aorta (12.5%) between 2001 and 2015. Furthermore, 299 female and 299 male patients matched by propensity score were compared. Patients with dissection of the aorta were excluded. Results Women were older (68.4 ± 9.9 vs. 65.8 ± 11.6 years; p = 0.002), had higher logistic EuroSCORE I (18.4 [11.7; 29.2] vs. 12.3% [7.4; 22.6]; p < 0.001), and significantly shorter cardiopulmonary bypass (CPB) time (132 [105; 175] vs. 150 [118; 192] minutes; p < 0.001), while mean MHCA time was longer (15 [13; 19] vs. 14 [12; 17] minutes; p = 0.003). Surgical procedures were less complex in women and they were treated more frequently by isolated supracoronary ascending aorta replacement (61 vs. 54%; p = 0.046). Postoperatively, men showed a higher incidence of neurologic complications (7.0 vs. 3.3%; p = 0.03). The 30-day mortality (women 4.9% vs. men 3.9%; p = 0.48) did not differ significantly, likewise after statistical matching (4.7 vs. 2.3%; p = 0.120). Age, CPB time, and blood transfusion, but not female gender, were risk factors for mortality in multivariable regression analysis. Conclusion This study supports the hypothesis that female gender is not associated with increased short-term mortality or perioperative adverse events in elective aortic surgery in MHCA.

Surgical Treatment of Aneurysms of the Ascending Aorta and Aortic Arch

1996 ◽  
Vol 4 (1) ◽  
pp. 37-39
Author(s):  
Ratna Magotra ◽  
Moinuddin Khaja ◽  
Rohit Shahani ◽  
Surendra Khanna ◽  
Majid Mukadam ◽  
...  
Keyword(s):  
Circulatory Arrest ◽  
Ventilatory Support ◽  
Neurological Complications ◽  
Late Presentation ◽  
Ascending Aorta ◽  
Profound Hypothermia ◽  
Low Cardiac Output ◽  
Transverse Arch ◽  
Formidable Challenge ◽  
Total Circulatory Arrest

Surgery for aneurysms of the aorta is a formidable challenge especially when these aneurysms involve the ascending aorta and the transverse arch. We have used the technique of cardiopulmonary bypass, profound hypothermia and total circulatory arrest with marked reduction in neurological complications. Availability of albumin coated and gelatin sealed grafts, as well as blood components, has reduced the associated bleeding problems. Ninety-six patients with aneurysms of the ascending aorta and the transverse arch were operated upon between 1983 and 1993. Patients with aneurysms of the sinus of Valsalva have not been included in this study. Syphilitic pathology was predominant in the group with late presentation of very large aneurysms. The mortality was 17.71% and was largely due to low cardiac output, prolonged ventilatory support, lung infections, and mediastinitis.

Profound hypothermia and circulatory arrest for aneurysm surgery

1995 ◽  
Vol 28 (4) ◽  
pp. 600
Author(s):  
Jun Seuk Chea ◽  
Byung Ho Lee ◽  
Mee Young Chung ◽  
Jin Deuk Joo
Keyword(s):  
Circulatory Arrest ◽  
Aneurysm Surgery ◽  
Profound Hypothermia
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