Modification of an Old Technique to Correct Kinking of Tubular Graft Interposed to Reconstruct Ascending Aorta

Nežić, Duško; Miličić, Miroslav; Boricic, Mladen; Mićović, Slobodan

doi:10.1016/j.hlc.2021.05.099

Cited by 2 publications

(1 citation statement)

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“…The main reason for graft kinking is inappropriate graft length, and the proper length and size of the graft must be carefully determined to prevent kinking of the graft. While several methods for correcting the kinked graft without cardiopulmonary bypass and aortic cross clamp have been described ( 5 , 6 ), these techniques have usually been applied immediately after graft interposition at the first surgery. Most cases of graft-associated hemolytic anemia have been treated by second surgeries to replace the graft ( 2 ).…”

Section: Discussionmentioning

confidence: 99%

Patient-specific stent for hemolytic anemia due to a kinked ascending aortic graft

Lee,

Lim,

Hong

et al. 2023

J Thorac Dis

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Hemolytic anemia after thoracic aortic surgery is rare. A 69-year-old female patient, who underwent ascending aorta replacement for acute type A aortic dissection 7 years ago, was transferred from another hospital due to hemolytic anemia necessitating regular blood transfusions. After engaging in interdisciplinary discussions, we ruled out alternative medical diagnoses and treatments, ultimately identifying the kinked aortic graft as the primary cause of hemolysis. Due to the patient’s comorbidity, it was deemed high-risk to perform a redo thoracic aorta surgery for the replacement of the kinked aortic graft. Therefore, we decided to insert a patient-specific bare-metal stent into the kinked aortic graft to alleviate the kinking and promote improvement in hemolysis. We decided to perform the stent procedure under local anesthesia. The bare-metal stent was designed to be approximately 15% larger than the size of the pre-existing kinked aortic graft. A stent measuring 32 mm × 80 mm was successfully inserted and ballooned within the patient’s ascending aortic graft. As a result, the patient’s hemolytic condition showed gradual improvement over time. In this way, we aim to share our experience of inserting a patient-specific bare-metal stent under local anesthesia in patients who exhibit mechanical hemolysis due to a kinked aortic graft, especially when redo surgery is considered high-risk.

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Section: Discussionmentioning

confidence: 99%