Surgery for pseudoaneurysm of the ascending aorta under moderate hypothermia

Area of Science:

• Cardiovascular Surgery
• Infectious Disease Complications
• Aortic Pathology

Background:

• Ascending aortic pseudoaneurysms are infrequent but serious complications post-cardiac surgery.
• Postoperative infection significantly increases the risk and complexity of managing these pseudoaneurysms, necessitating surgical intervention and antibiotics.
• Large retrosternal pseudoaneurysms pose a substantial risk of catastrophic hemorrhage during resternotomy.

Observation:

• A case of a large, infected pseudoaneurysm of the ascending aorta was identified in the retrosternal space following cardiac surgery.
• The patient presented a high risk for massive bleeding due to the pseudoaneurysm's size and location, complicating standard surgical re-entry.
• Conventional resternotomy was deemed excessively hazardous due to the potential for rupture.

Findings:

• A novel surgical approach utilizing femoro-femoral bypass under moderate hypothermia with transient circulatory arrest was successfully implemented.
• This strategy effectively circumvented the risks associated with direct retrosternal access and resternotomy.
• The procedure resulted in the successful management of the ascending aortic pseudoaneurysm without operative complications.

Implications:

• This case demonstrates a viable and safe alternative strategy for managing large, infected ascending aortic pseudoaneurysms in the retrosternal space.
• The femoro-femoral bypass technique offers a crucial option to mitigate bleeding risks in high-risk patients.
• This approach may enhance surgical outcomes for complex aortic pathologies following cardiac procedures.