Total replacement of the transverse aortic arch with the Gott aneurysm shunt

A new method of temporary external shunting for total replacement of the aortic arch is described. Its greatest advantage is that systemic heparinization is not required. In a 46-year-old man total body perfusion was achieved with two 9-mm Gott aneurysm shunts inserted between the ascending aorta and both femoral arteries. Blood supply to the brain was maintained with the cut halves of a 7-mm Gott shunt connected as side branches to one of the 9-mm shunts, allowing cannulation of both carotid arteries. The total cardiac output, measured at 4.7 L/min by the thermodilution technique through a Swan-Ganz catheter, was propelled through these preheparinized multibranch shunts. A flowmeter adapted on one of the 9-mm Gott shunts demonstrated a shunt flow of 2000 ml/min and it was deduced that the other 2700 ml of the total cardiac output was delivered by the other shunt. During the 29 minutes of cross-clamping, there was no change in the filling pressure of either the right heart (central venous pressure 5 cm H2O) or the left heart (pulmonary wedge pressure 8 mm Hg). Aortic continuity was reestablished with the interposition of a 34-mm tubular woven Dacron prosthesis, on which two 10-mm woven Dacron side branches were anastomosed to the innominate and left common carotid arteries. The patient had no neurologic deficit and had normal physiologic function of all other organs.