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Published on: December 11, 2017
Surgical experience of ascending aorta and aortic valve replacement in patient with calcified aorta
Suryeun Chung1, Pyo Won Park, Min Suk Choi
1Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
Insights
Hypothermic circulatory arrest safely treats patients with calcified aorta during ascending aorta and aortic valve replacement, avoiding cerebral infarcts. This technique offers a viable alternative to conventional aortic cross-clamping in high-risk individuals.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Conventional aortic cross-clamping poses risks of cerebral infarct due to aortic calcification.
- Ascending aorta and aortic valve replacement present challenges in patients with calcified aortas.
Purpose of the Study:
- To evaluate the safety and efficacy of hypothermic circulatory arrest for ascending aorta and aortic valve replacement in patients with calcified aortas.
Main Methods:
- Retrospective study of 11 patients undergoing ascending aorta and aortic valve replacement with hypothermic circulatory arrest.
- Analysis of patient demographics, surgical techniques, bypass times, and clinical outcomes.
Main Results:
- No new cerebral infarcts or cardiovascular accidents occurred post-surgery.
- Zero hospital mortality; one early reoperation for bleeding and one late reoperation for prosthetic valve endocarditis.
- Mean follow-up of 32 months with one late mortality due to unknown causes.
Conclusions:
- Hypothermic circulatory arrest is a safe and effective technique for aortic valve and ascending aorta replacement in patients with calcified aortas.
- This method mitigates the risk of embolism associated with conventional aortic cross-clamping.
Background:
The conventional method of aortic cross-clamping is very difficult and increases the risk of cerebral infarct due to embolism of the calcified aorta in these patients. Accordingly, we analyzed our experience with 11 cases of ascending aorta and aortic valve replacement with hypothermic circulatory arrest.
Materials And Methods:
From January 2002 to December 2009, 11 patients had ascending aorta and aortic valve replacement with hypothermic arrest at our hospital. We performed a retrospective study.
Results:
There were 5 males and 6 females, with a mean age of 68 years (range, 44 to 82 years). Eight patients had aortic stenosis, and 3 patients had aortic regurgitation. An aortic cannula was inserted into the right axillary artery in 3 patients and ascending aorta in 6 patients. Two patients with aortic regurgitation had a remote access perfusion catheter inserted though the right femoral artery. The mean cardiopulmonary bypass time was 180 minutes (range, 110 to 306 minutes) and mean hypothermic circulatory arrest time was 30 minutes (range, 20 to 48 minutes). The mean rectal temperature during hypothermic circulatory arrest was 21℃ (range, 19℃ to 23℃). No patient had any new onset of cerebral infarct or cardiovascular accident after surgery. There was no hospital mortality. Early complications occurred in 1 patient who needed reoperation due to postoperative bleeding. Late complications occurred in 1 patient who underwent a Bentall operation due to prosthetic valve endocarditis. The mean follow-up duration was 32 months (range, 1 month to 8 years) and 1 patient died suddenly due to unknown causes after 5 years.
Conclusion:
Patients with a calcified aorta can be safely treated with a technique based on aorta and aortic valve replacement under hypothermic circulatory arrest.
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