A mismatch between SVG diameter and RCA diameter has an impact on the patency rate of the SVG. Evaluation of the saphenous vein before surgery and selection of a graft to minimize mismatch should improve SVG patency.
We describe a simple and reproducible technique to achieve complete and immediate hemostasis of the distal anastomosis in total arch replacement with the frozen elephant trunk technique. The adventitia was left seamlessly 1.0 cm longer than the level of the suture line. The adventitial remnant covered most of the distal anastomosis line tightly while the distal anastomosis was completed with continuous sutures. The adventitia was thin and tough, making it suitable to cover the suture line. This technique can contribute to eliminating bleeding from the distal anastomosis independent of unreliable blood coagulability during aortic surgery for acute aortic dissection.
A 63-year-old man with ruptured acute type A aortic dissection was referred to our hospital. Computed tomography showed a false aneurysm arising from the false lumen located beside the ascending aorta. His hemodynamic status was stable inspite of the ruptured acute aortic dissection. We consider that the containment of the false aneurysm by thin mediastinal structures prevented worsening of his hemodynamic status, and this is extremely rare.Keywords: aneurysm, aortic dissection, aortic operation surgery. When he arrived at our hospital, his hemodynamic status was stable, his blood pressure was 110/78 mmHg and his heart rate was 78 beats/min (regular). CT fi lms from the referring hospital showed pericardial effusion and a ruptured type A aortic dissection with a primary entry tear in the distal aortic arch (Fig. 1A). In addition, there was a false aneurysm arising from the false lumen that was enhanced in the early phase (Fig. 1B). The false aneurysm was located beside the ascending aorta and expanding into the transverse sinus (Fig. 1C, D). We performed an emergency operation. After median sternotomy, the pericardial cavity was found to be fi lled with old blood, and there was no pericardial adhesion. Total cardiopulmonary bypass was initiated with retrograde perfusion through the femoral artery and bicaval venous drainage with left ventricular venting. After antegrade cold blood cardioplegia was selectively administered, cardiac arrest was obtained. However we could not fi nd the tear of adventitia which had caused the false aneurysm, we could identify the false aneurysm surrounded by connective tissue and hematoma. We thought that the tear of adventitia was located in the ascending aorta because adventitia of the aortic root was not ruptured. The transected proximal stump of the ascending aorta was reconstructed with both inner and outer Tefl on felt. He was cooled to 28°C, the ascending aorta was opened and selective antegrade cerebral perfusion was established. We performed total arch replacement using Dacron graft. Thoracic endovascular aortic repair was performed to close the primary entry 12 days after the surgery. The false aneurysm was not seen on the postoperative CT (Fig. 2), and his postoperative course was satisfactory.
DiscussionFalse aneurysm is a rare and life threatening complication that occurs in 0.5% of all cardiac surgical cases. 2) False aneurysm of the thoracic aorta results from transmural disruption of the aortic wall and is contained by the surrounding mediastinal structures. When the pressure in the
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