Working Environment of Cardiovascular Surgeons in Japan:A Survey of Work Hours, Payment, and Task-Shifting

Takumi Kawase＊	Kyokun Uehara＊	Yosuke Inoue＊
Atsushi Omura＊	Yoshimasa Seike＊	Hiroaki Sasaki＊
Hitoshi Matsuda＊	Junjiro Kobayashi＊

（Department of Cardiovascular Surgery, National Cerebral and Cardiovascular＊, Suita, Japan）

Introduction:Prevention of embolic stroke is the key issue to perform aortic arch replacement in patients with a shaggy aorta. The aim of this study is to report the utility of the isolation technique for total arch replacement in patients with a shaggy aorta. Methods:Clinical results of seven patients（71.7 years old, all men）with a shaggy aorta who underwent total arch replacement between January 2017 and November 2018 were retrospectively reviewed. The operative indications were a distal arch or proximal descending aortic aneurysm in 6 patients and a thrombus inside brachiocephalic artery in one. A cerebral perfusion was established by inserting a cannula directly into all supra-aortic branches before starting systemic perfusion. Result:Utilizing the isolation technique with clamping of all branches in 4 patients and the functional isolation technique with clamping of two branches in 3, total arch replacement was performed in all patients（operation time:513 min, selective cerebral perfusion time:162 min). No operative death was observed and no newly developed stroke was encountered. Conclusion:The isolation technique is a useful method to prevent stroke during total arch replacement in patients with a shaggy aorta.

 

Jpn. J. Cardiovasc. Surg. 49:93-98（2020）

Keywords：isolation technique;aortic arch replacement;shaggy aorta