Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Arch-First Technique in Aortic Arch Aneurysm - 2case report -

Arch-First Technique을 이용한 대동맥궁 대동맥류의 수술 - 2례 보고 -

  • 박광훈 (인제대학교부산백병원 흉부외과 교실) ;
  • 최석철 (인제대학교 의과대학 부산 백병원 흉부외과 체외순환 연구실) ;
  • 최강주 (인제대학교부산백병원 흉부외과 교실) ;
  • 이양행 (인제대학교부산백병원 흉부외과 교실) ;
  • 황윤호 (인제대학교부산백병원 흉부외과 교실) ;
  • 조광현 (인제대학교부산백병원 흉부외과 교실)
  • Published : 2000.08.01
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Abstract

To minimize the period of brain ischemia and the potential for neurologic damage during aortic arch replacement, we used the arch-first technique. First case was a 28-year-old female with extensive aneurysm involving ascending, arch and descending thoracic aorta. Exposure was obtained via a bilateral via a bilateral thoracotomy (clamshell incision) in the anterior 4th right and 3rd left intercostal space with oblique sternotomy. To prepare for arch perfusion, the side-arm graft(10mm) was anastomosed to the aortic graft, opposite the site of the planned anastomosis to the arch vessels. After completing the arch anastomosis under total circulatory arrest(37min) and retrograde cerebral perfusion(12min), aortic graft was clamped on either side and the arch was perfused via side-arm graft for 36min. When distal aortic anastomosis was finished, distal clamp of aortic graft was released and arch vessels were perfused via common femoral artery, and the proximal aortic anastomosis was accomplished. The patient was discharged with no event. Second case was a 48-year-old male with extensive aneurysm involving ascending, arch, and aortic regurgitaiton(grade III/IV). This case was also done using the clamshell incision. Aortic valve replacement was done by valved-conduit(Vascutek 30mm), both coronary artery anastomosis using Cabrol's procedure. Last operation procedure was the same as the 1st case.

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References

  1. J Thorac Cardiovasc Surg v.106 Deep hypothermia and early mortality in 656 patients Svensson LG;Crawford ES;Hess KR(et al)
  2. J Thorac Cardiovasc Surg v.115 Proximal aortic perfusion for complex arch and descending aortic disease Stephen W;Takahiro K
  3. J Cardiac Surg v.109 Cerebral consequences of hypothermic circulatory arrest in adults Griepp EB;Griepp RB
  4. Anesthesiology v.75 The relationship among canine brain temperature, metabolism, and function during hypothermia Michenfelder JD;Milde JH
  5. Pediatries v.87 Cognitive developement following repair as neoantes of transposition of the great arteries using deep hpothermic circulatory arrest Bellinger DC;Wernovsky G;Rapaport La(et al)
  6. N Engl J med v.332 Development and neurologic status of cluldren after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass Bellinger DC;Jonas AR;Rapport LA(et al)
  7. J Cardiovasc Surg v.9 Surgical treatment of aneurysm or dissection involving the ascending aorta and aortc arck, utilizing circulatory arrest and retrograde cerebial perfusion ueda Y;Miki S;Kusuhata K(et al)
  8. J Card Surg v.9 Hypothermic circulatory arrest and other methods of cerebral protection during operation on the thoracic aorta Ergin MA;Griepp EB;Lansman SL;Galla JD;Levy M;Griepp RB
  9. J Thorac Cardiovasc Surg v.117 Single-stage extensive replacement of the thoracic aorta: The arch-first technique Chris KR;Nicholas TK