Non Clamping Anastomosis of the Ascending and Arch Aneurysm Using Retrograde Cerebral Perfusion

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概要

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• Twelve consecutive patients requiring surgery for replacement of ascending aortic aneurysms (n = 3), ascending arch aortic aneurysms (n = 2), or type A aortic dissections (n = 7) were treated without aortic cross clamping. Retrograde cerebral perfusion (RCP) with circulatory arrest (mean RCP time: 46.0 +/- 15.9 minutes, range 20 to 65 minutes) and continuous retrograde cardioplegia (mean cardiac ischemic time: 134.4 +/- 39.7 minutes, range: 40 to 180 minutes) were employed. In the patients with aortic dissection, the intimal tear at the origin of the brachiocephalic artery (BCA) was resected completely, the aortic wall was trimmed and closed with Teflon felt. The distal anastomosis was created using an open technique. Air and debris were completely evacuated by returning blood from the cerebral vessels and femoral artery. Then the artificial graft was clamped, and cardiopulmonary bypass resumed. The proximal anastomosis was performed during rewarming. The operations were elective in seven cases, and emergent in five cases. Graft replacement of the ascending aorta was performed in ten patients (including two BCA reconstructions). The remaining two patients were treated by patch repair (n = 1), primary anastomosis (n = 1). There were no perioperative deaths. One patient had a transient neurological deficit. The distal false lumen was occluded completely in five of seven patients with aortic dissections. The other two patients had a secondary tears in the descending aorta. Thus retrograde cerebral perfusion and continuous retrograde cardioplegia without aortic cross clamping is an effective technique in the replacement of the ascending and arch aorta.

著者

• OKADA Masayoshi

  Division of Pharmacology, Department of Molecular Genetics and Signal Transduction Research, Course

• WAKIYAMA HIDETAKA

  Department of Surgery, Division II, Kobe University School of Medicine

• Okada Masayoshi

  Division Of Pharmacology Department Of Molecular Genetics And Signal Transduction Research Course Fo

• Okada Masayoshi

  2nd Department Of Surgery Kobe University School Of Medicine

• Okada Masayoshi

  Second Department Of Surgery Kobe University School Of Medicine

• Okada Masayoshi

  Second Division Department Of Surgery University School Of Medicine

• Tobe Satoshi

  Division Ii Department Of Surgery Kobe University School Of Medicine

• Azami Takashi

  Second Division Department Of Surgery Kobe University School Of Medicine

• WAKIYAMA Hidetaka

  Division of Cardiovascular Surgery, Hyogo Brain and Heart Center

• Yamashita Chojiro

  Division II,Department of Surgery,Kobe University School of Medicine

• Yoshimura Hideki

  Division II,Department of Surgery,Kobe University School of Medicine

• Azami Takashi

  Division II,Department of Surgery,Kobe University School of Medicine

• Nakagiri Keitarou

  Division II,Department of Surgery,Kobe University School of Medicine

• Ataka Keiji

  Division II,Department of Surgery,Kobe University School of Medicine

• Nakamura Hiroomi

  Division II,Department of Surgery,Kobe University School of Medicine

• Yoshimura Hideki

  Division Ii Department Of Surgery Kobe University School Of Medicine

• Nakamura Hiroomi

  Division Ii Department Of Surgery Kobe University School Of Medicine

• Tobe Satoshi/Ataka

  Division II,Department of Surgery,Kobe University School of Medicine/Division II,Department of Surge

• Tobe Satoshi/ataka

  Division Ii Department Of Surgery Kobe University School Of Medicine/division Ii Department Of Surge

• Yamashita C

  Department Of Surgery Second Division Kobe University School Of Medicine

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