Surgical Repair of Massive Ascending Aortic Pseudoaneurysm: Preparation, Execution, and Lessons Learned

Surgical management of aortic pseudoaneurysm is a distinct challenge, requiring careful attention to cardiac and cerebral protection.

A 58-year-old man presented with ascending aortic pseudoaneurysm in the setting of prior dissection repair, with active inflow from the pseudoaneurysm to the false lumen of the aortic arch. With cannulation of the axillary artery and femoral vein, direct cannulation of the right carotid artery for antegrade cerebral perfusion, and direct venting of the left ventricle, the brain and heart were protected prior to sternotomy, allowing for safe cooling and circulatory arrest upon disruption of the pseudoaneurysm. Zone 2 aortic arch replacement was completed, and the patient recovered well and was discharged to rehabilitation postoperatively.

This report highlights the management considerations when approaching repair of a complex aortic pseudoaneurysm, including planning, cardiopulmonary bypass setup, and surgical execution.

This surgical approach may be considered by surgical teams for management of high-risk reoperative aortic surgery.