Contained local compression on peri-ascending aortic area for postoperative bleeding control: a case report.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Surgical Innovation

Background:

• Uncontrollable postoperative bleeding is a critical complication after type A acute aortic dissection (AAD) repair or modified Bentall procedures.
• Managing this bleeding often requires extensive blood transfusions, intensive monitoring, and potentially reoperation.
• Fragile tissues at anastomotic sites or the aortic root contribute to this surgical challenge.

Purpose of the Study:

• To present a novel technique for managing uncontrollable postoperative bleeding in complex aortic surgeries.
• To evaluate the efficacy of contained local compression using bovine pericardium in critical bleeding scenarios.

Main Methods:

• A technique involving contained local compression of the upper heart with bovine pericardium was applied.
• The compression extended from the upper right ventricle to above the innominate vein, with closure of the transverse sinus.
• This method was used in two patients experiencing uncontrolled bleeding post-AAD repair and modified Bentall procedure.

Main Results:

• Both patients experienced a smooth postoperative course with minimal blood transfusion needs.
• Reoperation for gauze removal was performed 2 days later in both cases without complications.
• The contained local compression effectively managed malignant bleeding from fragile aortic tissues.

Conclusions:

• Contained local compression using bovine pericardium is a potentially valuable strategy for managing severe bleeding after aortic dissection and root repair.
• This technique may reduce the need for blood transfusions and reoperations, improving patient outcomes.
• Further investigation into this innovative surgical approach is warranted.