Establishment of extracorporeal circulation during open descending and thoracoabdominal aorta repair is necessary in almost all patients. Full cardiopulmonary bypass (CPB) with peripheral cannulation and left heart bypass are the most commonly used circulatory support strategies and they effectively minimize the risk of visceral and central nervous system ischemia. However, both strategies are associated with significant drawbacks. In this video tutorial we present 2 cases demonstrating an alternative strategy for CPB establishment during descending or thoracoabdominal aortic repair. This technique uses two simultaneous (proximal and distal) aortic perfusion cannulas and a single-stage right atrial cannula, both inserted through the main incision. This technique offers all the advantages of full CPB while lowering the risk of proximal hypoperfusion syndrome, and the use of central cannulas virtually eliminates the risk of retrograde perfusion. Complications associated with femoral incision/cannulation are avoided and excellent venous drainage is achieved. This alternative CPB strategy increases the surgical options for extensive thoracoabdominal aortic repair and allows bespoke management for this complex disease.
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http://dx.doi.org/10.1510/mmcts.2019.044 | DOI Listing |
Semin Thorac Cardiovasc Surg
December 2024
Division of Cardiovascular and Thoracic Surgery, UTMB-Galveston, Galveston, TX. Electronic address:
Indian J Thorac Cardiovasc Surg
January 2025
Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Vadapalani, Chennai 600026 India.
Spinal cord ischemia (SCI) is a major debilitating complication of thoraco-abdominal aortic aneurysm (TAAA) repair, even in experienced centers. Several strategies are employed to reduce the incidence of SCI and the resultant paraplegia, yet the optimum method is unknown. We describe our experience of using the reversed saphenous vein graft (RSVG) as a conduit to reimplant the intercostal arteries (ICAs).
View Article and Find Full Text PDFKyobu Geka
December 2024
Department of Thoracic and Cardiovascular Surgery, Saga University, Saga, Japan.
We report a rare case of rupture without bleeding secondary to endotension after thoracic endovascular aneurysm repair. An 82-year-old woman had undergone multiple thoracic endovascular aortic repairs for a distal arch aneurysm. Due to the aneurysm enlargement, stent graft was eventually placed from the ascending aorta to just above the celiac artery after axillo-axillo-common carotid artery bypass.
View Article and Find Full Text PDFKhirurgiia (Mosk)
December 2024
Petrovsky National Research Center of Surgery, Moscow, Russia.
Objective: To demonstrate successful treatment of a patient with aneurysmal lesions of several aortic segments.
Material And Methods: A patient with myelodysplastic syndrome and pancytopenia underwent endovascular repair for abdominal aortic aneurysm. Aneurysm of common iliac artery and borderline thoracic aortic aneurysm occurred 2 years after surgery.
Eur Heart J Case Rep
December 2024
Department of Cardiac Surgery, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400030, China.
Background: Few studies have investigated the effect of the intimal morphology of type B aortic dissection (TBAD) on the blood flow after rupture. We report a case of a 30-year-old male with complicated TBAD, who underwent assessment with 4D computed tomography (4D-CT).
Case Summary: Patient presented with chest tightness for 14 days, a heart rate of 67 b.
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