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[Separate operation for extensive aneurysm (mega-aorta) complicated with ischemic heart disease]
S Yamashiro1, R Sakata, Y Nakayama
1Department of Cardiovascular Surgery, Kumanoto Chyuou Hospital, Japan.
The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|October 24, 1998
Summary
This study presents a two-stage surgical approach for complex aortic aneurysms. Segmental aortic clamping and selective visceral perfusion effectively prevented spinal cord and organ ischemia in a patient with thoracoabdominal aortic aneurysm.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Aneurysm Repair
Background:
- Thoracoabdominal aortic aneurysms (TAAA) pose significant surgical challenges, particularly Type II TAAAs involving the aortic arch.
- Ischemic heart disease complicates management, necessitating careful consideration of cardiopulmonary bypass strategies.
- The elephant trunk technique is a common approach for aortic arch and descending aorta repair.
Observation:
- A 71-year-old woman with a Type II TAAA and ischemic heart disease underwent a staged repair.
- Initial surgery involved ascending aorta and arch replacement with elephant trunk technique and simultaneous coronary artery bypass grafting (CABG).
- Postoperative CT revealed enlargement of the abdominal aortic aneurysm, necessitating a second intervention.
Findings:
- The second operation utilized Stoney's spiral opening method with revascularization of spinal arteries (Th6, 7, 9) and segmental aortic clamping to prevent spinal cord ischemia.
- Selective perfusion to visceral arteries and femoro-femoral (F-F) bypass were employed to prevent visceral ischemia, with flow rates of 50-100 ml/min.
- No hepatorenal dysfunction or paraparesis occurred postoperatively.
Implications:
- Segmental aortic clamping combined with selective visceral perfusion and F-F bypass appears effective in preventing spinal cord and abdominal organ ischemia during complex aortic aneurysm repair.
- This staged approach may offer a viable strategy for managing extensive aortic pathologies with associated comorbidities.
- Further studies are warranted to validate these findings in a larger patient cohort.