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Simultaneous total aortic replacement from arch to bifurcation: experience with six cases.
C G Massimo1, A G Poma, R R Viligiardi
1Department of Cardiovascular Diseases, Careggi Hospital, Firenze, Italy.
Texas Heart Institute Journal
|March 1, 1986
Summary
Simultaneous total aortic replacement is a feasible surgical technique for complex aortic diseases. This hypothermic extracorporeal circulation method allows for extensive aortic repair, offering a viable option for patients with dissections and aneurysms.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Complex aortic pathologies, including dissections and aneurysms, often require extensive surgical intervention.
- Total aortic replacement presents significant surgical challenges due to the complexity of the aorta and its branches.
Purpose of the Study:
- To evaluate the feasibility and outcomes of simultaneous total aortic replacement, encompassing the aortic arch and abdominal aorta.
- To describe the surgical technique involving profound hypothermia and extracorporeal circulation for extensive aortic repair.
Main Methods:
- Six patients underwent simultaneous total aortic replacement for acute dissection, chronic dissection with ischemia, or multiple aneurysms.
- The technique involved general hypothermia (20°C core temperature) with extracorporeal circulation, aortic arch replacement, followed by abdominal aorta replacement during hypothermic ischemia.
- Dual arterial return cannulation (ascending aorta and femoral artery) was used to maintain perfusion during aortic occlusion.
Main Results:
- Three patients survived and remained in good functional condition for 6 to 27 months post-operation.
- Two patients died early from bleeding complications (3-6 hours post-op).
- One patient died at 1 month without neurological complications; no medullary injury was definitively ascertained.
Conclusions:
- Simultaneous total aortic replacement using a profound hypothermic technique is feasible for complex aortic conditions.
- The described surgical approach allows for extensive aortic repair, including the arch and abdominal aorta, with acceptable outcomes in select cases.