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Total aortic arch replacement for a patient with poor left ventricular function and patent coronary artery bypass

Kosaku Nishigawa1, Hiroshi Kubo, Yasuhiro Yunoki

  • 1Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan. nippie550102@yahoo.co.jp

General Thoracic and Cardiovascular Surgery
|July 14, 2011
PubMed

Insights

This study presents a novel surgical technique for aortic arch aneurysm repair in patients with prior coronary artery bypass grafting (CABG). A Y-shaped graft ensured effective myocardial protection during complex aortic arch surgery.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Surgery

Background:

  • A 66-year-old male with a history of coronary artery bypass grafting (CABG) presented with a ruptured aortic arch aneurysm.
  • The patient had patent grafts, including a left internal thoracic artery (LITA) to the left anterior descending artery (LAD), but also suffered from left ventricular dysfunction.
  • Coronary angiography revealed LAD occlusion and proximity of the aneurysm to the LITA graft, posing a significant surgical risk.

Observation:

  • The patient required surgical treatment for a ruptured aortic arch aneurysm.
  • The anatomical complexity included a patent LITA graft near the aneurysm, increasing the risk of intraoperative injury.

Findings:

  • A total aortic arch replacement was successfully performed using a Y-shaped composite saphenous vein graft (SVG).
  • This technique facilitated effective myocardial protection through the administration of cardioplegic solution.
  • The procedure addressed the challenging anatomical constraints posed by the prior CABG and aneurysm location.

Implications:

  • This Y-graft approach offers a viable and effective myocardial protection strategy for complex aortic arch surgery in patients with prior CABG and patent LITA grafts.
  • It represents a valuable treatment option for high-risk surgical cases involving aortic arch pathology post-CABG.
  • The findings highlight the importance of tailored surgical techniques for complex cardiovascular reconstructions.

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