| Recent Surgical Results of Transverse
Aortic Arch Replacement |
(Department of Cardiovascular Surgery, Kochi Municipal
Hospital, Kochi, Japan)
| Tomoaki Suzuki |
Atsushi Takamori |
Fuyuhiko Yasuda |
| Chiaki Kondo |
Manabu Okabe |
|
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We report the results of aortic
arch replacement in 32 patients (20 males, 12 females) with aortic
arch aneurysm, including 9 emergency cases. The etiology of aneurysm
was atherosclerotic aneurysm in 18 patients, pseudoaneurysm in
1 patient, and aortic dissection in 13 patients. Selective cerebral
perfusion (SCP) and retrograde cerebral perfusion (RCP), which
are used for brain protection during aortic arch reconstruction,
were both employed in this study according to our institutional
policy. RCP was started at the moment of circulatory arrest after
which the aneurysm was opened. In the case of 1-branch reconstruction
or hemiarch replacement, we only employed RCP. If 2-branch reconstruction
or total arch replacement was needed, we switched to SCP. After
the distal graft anastomosis was performed, antegrade systemic
perfusion was started via the 4th branch of the graft. Subsequently,
3 arch vessels was reconstructed with rewarming to shorten the
SCP time, and finally proximal graft anastomosis was performed.
Distal graft anastomosis with a new technique was applied in
the 10 most recent cases. The “cuff” was made at the distal anastomosis
site of the graft beforehand and this “cuff” was sutured to the
aortic wall in an elephant-trunk fashion. This technique was
a simple approach to repairing the distal lesion and allowed
easy addition of stitches in case's of bleeding. The in-hospital
mortality rate was 6.3% (2 of 32 patients) and the rate of cerebrovascular
accident was 6.3% (2 of 32patients). This technique for aortic
arch repair is a useful method that results in low rates of in-hospital
mortality and morbidity.
Jpn. J. Cardiovasc. Surg. 32：13-16 (2003) |
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