Insufficient unilateral cerebral perfusion during emergent aortic arch surgery.

A rare case of insufficient right-sided unilateral cerebral perfusion during emergent aortic arch replacement in a patient with an acute aortic dissection is reported. On the basis of intraoperative monitoring using near-infrared spectroscopy, the insufficient perfusion of the contralateral hemisphere was detected and the bilateral perfusion was performed, which led to normalization of cerebral perfusion and an uncomplicated neurological outcome.

Mild-to-moderate hypothermia in aortic arch surgery using circulatory arrest: a change of paradigm?

Objectives: Antegrade cerebral perfusion makes deep hypothermia non-essential for neuroprotection; therefore, there is a growing tendency to increase the body temperature during circulatory arrest with selective brain perfusion. However, very little is known about the clinical efficacy of mild-to-moderate hypothermia for ischemic organ protection during circulatory arrest. The aim of this study was to evaluate the safety and efficiency of mild-to-moderate hypothermia for lower-body protection during aortic arch surgery with circulatory arrest and antegrade cerebral perfusion.

Ascending-to-descending bypass for simultaneous surgery of aortic coarctation with other cardiac pathologies.

Background: The appropriate approach for aortic coarctation associated with other cardiac diseases necessitating surgery is still controversial. The aim of this study was to evaluate the results after simultaneous surgery performed via median sternotomy and consisting of extra-anatomical ascending-to-descending aortic bypass and various other cardiac procedures.

Methods: Between January 1999 and February 2009, 13 consecutive patients with aortic coarctation coexistent with other cardiac diseases necessitating surgery underwent simultaneous surgery via median sternotomy.

Use of a carotid artery for arterial cannulation: side-related differences.

Background: Cannulation of arch arteries (innominate, axillary or carotid) for arterial return during cardiopulmonary bypass is increasingly being used; however, the flow and pressure profile in the cannulated arteries remains unclear. The aim of this study was to evaluate the flow and pressure characteristics of arterial inflow through a carotid artery, especially with regard to operative and technical aspects, clinical outcomes, and side-related differences.

Methods: Between January 2005 and April 2008, 200 consecutive patients underwent elective aortic arch surgery at our facility.

Modified bio-Bentall procedure: 10-year experience.

Objective: Biological aortic valve conduits are rarely used because of the concern that possible structural valve deterioration would require complete conduit replacement in a technically demanding operation. The aim of the study was to evaluate the 10-year experience with complete aortic-root replacement using a modified composite graft in which biological valve prosthesis was located inside the vascular graft allowing its replacement within the tube and leaving the coronary ostia untouched.

Methods: Self-assembled composite grafts as described have been used in our clinic since 1998 as the standard for patients needing a biological aortic-root replacement.

Unilateral cerebral perfusion: right versus left.

Objectives: Unilateral cerebral perfusion for brain protection is gaining increasing interest, although the pathways of collateral flow as well as many aspects of the surgical strategy regarding optimal perfusion pressure, flow and temperature remain unclear. This study evaluates the differences between right- and left-sided unilateral cerebral perfusion, if any, especially with regard to neurovascular monitoring findings and clinical outcome.

Methods: Between January 2005 and April 2008, 200 consecutive patients underwent elective aortic arch surgery at our facility.

Aortic valve insufficiency with extensive cusp pathology: repair with a pericardial patch.

The novel repair technique for aortic insufficiency with extensive cusp pathology using autologous pericardium is described. The technique has been used in 19 consecutive patients offering excellent functional results with a large coaptation area.

Replacement of valve prosthesis within aortic composite graft.

A 64-year-old man was referred for aortic valve re-replacement due to moderate-to-severe stenosis that developed 10 years after complete aortic root replacement using a stentless valve composite graft. He also had coronary heart disease and a mitral valve defect with predominant insufficiency. The patient underwent re-do surgery consisting of coronary artery bypass grafting, mitral valve replacement, and replacement of the valve prosthesis within the aortic conduit, which I believe is the first report of such a procedure.

Contained rupture of the aorta in acute Stanford type A aortic dissection causing right ventricular wall dissection.

We describe a rare case of an acute aortic type A dissection after previous aortic valve replacement and coronary artery revascularization complicated by a contained rupture and right ventricular wall dissection. Although preoperatively echocardiography and CT scan described a pericardial hematoma, intraoperatively no intrapericardial hematoma was found; instead an extended right ventricular wall dissection caused by a large thrombus formation within the right ventricular muscle layers was demonstrated. After replacement of the ascending aorta and removal of the thrombus as the sole treatment for right ventricular wall dissection, the two dissected layers of the right ventricular wall were contracting synchronously again.

Does anatomical completeness of the circle of Willis correlate with sufficient cross-perfusion during unilateral cerebral perfusion?

Objectives: The aim of the study was to evaluate the role of anatomical completeness of the circle of Willis for sufficient brain perfusion during unilateral cerebral perfusion and the methodology of the preoperative and intraoperative functional assessments of adequate cross-perfusion.

Methods: This prospective observational study included all elective patients (99) who underwent elective open arch surgery (hemiarch in 74 and arch replacement in 25 patients, respectively) at our institution between September 2004 and September 2006. Preoperative neuro-vascular evaluation included color-coded duplexsonography of the extracranial arteries, cranial CT angiography, and transcranial sonography.

Carotid artery cannulation in aortic surgery.

Objective: Carotid artery cannulation was initially established at our clinic for surgery of acute aortic dissection, and it became the standard approach for procedures in which circulatory arrest is necessary. The aim of the study was to evaluate this method's efficiency regarding postoperative outcomes after the first 100 procedures.

Methods: Between July 2002 and October 2005, 100 patients underwent aortic surgery using carotid artery cannulation by a side graft for arterial return with a mean flow rate of 4.