Successful Management of Acute Type A Aortic Dissection in a 305 kg Patient Using Two Oxygenators in Parallel

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Patient factors, such as extreme obesity, pose significant challenges in emergent aortic surgery.
• Acute type A aortic dissection requires timely and complex surgical intervention.

Purpose of the Study:

• To report a successful surgical management of acute type A aortic dissection in a patient with extreme obesity.
• To highlight critical components for favorable outcomes in complex aortic surgeries.

Main Methods:

• Mechanical aortic root, ascending aorta, and Zone 2 arch replacement.
• Hypothermic circulatory arrest.
• Utilized a dual-oxygenator bypass circuit, proactive metabolic management, bilateral fasciotomies, and early renal replacement therapy.

Main Results:

• Successful completion of the aortic repair procedure.
• Favorable patient outcome despite significant surgical challenges.
• Demonstrated the feasibility of advanced surgical techniques in high-risk patients.

Conclusions:

• Emergent aortic surgery in patients with extreme obesity is feasible with meticulous planning and execution.
• Advanced techniques like dual-oxygenator bypass and proactive organ support are crucial for managing complex aortic dissections in obese patients.
• This case underscores the importance of tailored perioperative strategies for high-risk surgical candidates.