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Carotid and aortic arch endarterectomy using hypothermic arrest with coronary bypass
H Nishida1, R K Grooters, A A Yeager
1Department of Surgery, Iowa Methodist Medical Center, Des Moines.
Insights
Deep hypothermic circulatory arrest safely protected a patient undergoing combined aortic arch endarterectomy and coronary artery bypass grafting. This approach may prevent cerebral embolization during complex cardiovascular procedures.
Area of Science:
- Cardiovascular Surgery
- Cerebrovascular Surgery
- Surgical Techniques
Background:
- Severe triple-vessel disease necessitates coronary artery bypass grafting (CABG).
- Symptomatic bilateral carotid artery obstructions and aortic arch atheroma present complex surgical challenges.
- Deep hypothermic circulatory arrest (DHCA) is a technique used to provide brain protection during aortic arch surgery.
Observation:
- A 67-year-old male patient presented with severe triple-vessel disease requiring CABG.
- The patient also had symptomatic bilateral carotid artery obstructions and a large, friable atheromatous plaque in the transverse aortic arch.
- A combined surgical approach was planned.
Findings:
- The patient underwent endarterectomy of the transverse aortic arch and left carotid endarterectomy.
- This was performed concomitantly with quadruple coronary artery bypass grafting.
- Deep hypothermic circulatory arrest was utilized during the combined procedure.
- The patient experienced an uneventful recovery.
Implications:
- Deep hypothermic circulatory arrest offers adequate cerebral protection for combined aortic arch and coronary artery bypass grafting.
- This surgical strategy may effectively eliminate cerebral embolization during complex cardiovascular interventions.
- The findings support the safety and efficacy of DHCA in managing patients with concurrent severe coronary and cerebrovascular disease.
Abstract:
A 67-year-old man with symptomatic bilateral carotid artery obstructions and a large, friable atheromatous plaque of the transverse aortic arch required coronary artery bypass grafting for severe triple-vessel disease. An endarterectomy of the transverse arch and a left carotid endarterectomy were performed using deep hypothermic circulatory arrest concomitant with quadruple coronary artery bypass grafting. Recovery was uneventful. Hypothermic circulatory arrest provides adequate protection for this combined procedure and may eliminate cerebral embolization.