초록접수 현황
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Single-Stage Open Repair of Extensive Aneurysm in the Arch and Descending Thoracic Aorta through Sternotomy
Joon Young Kim, Hong Rae Kim, Joon Bum Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
Purpose : Patients with extensive thoracic aortic diseases involving ascending, arch, and descending thoracic aorta may require multiple surgical and interventional managements that pose cumulative surgical trauma and risks of interval mortality. The present paper describes two cases of a single-stage arch and descending thoracic aorta replacement via a sternotomy approach in patients with multiple comorbidities presenting with extensive thoracic aortic aneurysm.
Methods : After median full sternotomy the surgery involved posterior pericardiotomy to approach distal descending aorta by retracting the heart to cephalad under full cardiopulmonary bypass and left ventricular venting. At nasopharyngeal temperature of 28’C to allow circulatory arrest, del Nido cardioplegia (1000cc) was infused through the aortic root after mid-ascending aorta clamping. Then, under antegrade cerebral perfusion, distal aorta was opened at the distal DTA through the posterior pericardiotomy site and a vascular graft was passed through a lumen of the DTA from distal arch to the distal DTA, at which distal anastomosis was made. Afterward, lower body perfusion was resumed through a side branch of the vascular graft., which was followed by arch vessel reconstruction, proximal aortic anastomosis and other combined procedures.
Results : Perioperative profiles are detailed in the Table. In summary, the procedures were successfully performed without early mortality or neurologic injuries in all cases, however, thoracic endovascular repair was required in a case who experienced lower body hypoperfusion casued by dominant distal false lumen flows through fenestrated flap.
Conclusion : This single-stage open aortic repair through sternotomy may be a reasonable approach to treat extensive aneurysm involving both the arch and descending thoracic aorta.
Methods : After median full sternotomy the surgery involved posterior pericardiotomy to approach distal descending aorta by retracting the heart to cephalad under full cardiopulmonary bypass and left ventricular venting. At nasopharyngeal temperature of 28’C to allow circulatory arrest, del Nido cardioplegia (1000cc) was infused through the aortic root after mid-ascending aorta clamping. Then, under antegrade cerebral perfusion, distal aorta was opened at the distal DTA through the posterior pericardiotomy site and a vascular graft was passed through a lumen of the DTA from distal arch to the distal DTA, at which distal anastomosis was made. Afterward, lower body perfusion was resumed through a side branch of the vascular graft., which was followed by arch vessel reconstruction, proximal aortic anastomosis and other combined procedures.
Results : Perioperative profiles are detailed in the Table. In summary, the procedures were successfully performed without early mortality or neurologic injuries in all cases, however, thoracic endovascular repair was required in a case who experienced lower body hypoperfusion casued by dominant distal false lumen flows through fenestrated flap.
Conclusion : This single-stage open aortic repair through sternotomy may be a reasonable approach to treat extensive aneurysm involving both the arch and descending thoracic aorta.
책임저자: Joon Bum Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
발표자: Joon Young Kim, E-mail : charismajunx@naver.com