Novel methods of myocardial protection and de-airing for complex descending aortic aneurysm surgery

A 64-year-old male who had previously undergone an aortic valve replacement and replacement of the ascending aorta presented with an 8 cm descending aortic aneurysm. A left thoracotomy was required to allow replacement of the aorta. However, due to longitudinal as well as transverse expansion, visualisation of the aortic arch was compromised, preventing cross-clamping of the proximal aorta. Cardiopulmonary bypass and deep hypothermic circulatory arrest were, therefore, required. An unusual method of cardioplegia delivery was used for myocardial protection, utilising a Foley catheter under direct vision as an alternative to more expensive percutaneous peripheral endoclamp devices. We also describe an unusual cardiopulmonary bypass circuit, with the dual use of a left atrial cannula for venting and also for re-establishing perfusion during de-airing.