Open Distal Anastomosis Technique for Ascending Aortic Aneurysm Repair without Cerebral Perfusion

Kaplan, Mehmet; Temur, Bahar; Can, Tolga; Abay, Günseli; Olsun, Adlan; Aydogan, Hakki

doi:10.1532/hsf.1284

Cited by 3 publications

(3 citation statements)

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“…As a part of our routine procedure, open-distal anastomosis was performed between the graft and distal aortic tissue. During DHCA, no cerebral perfusion was performed [Kaplan 2015].…”

Section: Operative Techniquementioning

confidence: 99%

A New Surgical Approach for Aortic Root Aneurysm and Small Aortic Annulus

Kaplan

Karaagac

Yesilkaya

et al. 2020

HSF

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Reconstruction of the aortic root in patients with aortic root aneurysm and small aortic annulus is an intricate surgical procedure. Here, we describe our technique performed in 2 patients, that involved aortic root enlargement with grafting in conjunction with annular implantation of the composite graft with a prosthetic mechanical valve, which allowed us to avoid incompatibility. This novel method offers an alternative combined surgical approach for patients with small aortic annulus and aortic root aneurysm that preserves the structure of the valved conduit at the level of the aortic annulus.

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“…As a part of our routine procedure, open-distal anastomosis was performed between the graft and distal aortic tissue. During DHCA, no cerebral perfusion was performed [Kaplan 2015].…”

Section: Operative Techniquementioning

confidence: 99%

A New Surgical Approach for Aortic Root Aneurysm and Small Aortic Annulus

Kaplan

Karaagac

Yesilkaya

et al. 2020

HSF

Self Cite

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“…After heparinization and cannulation, CPB was started. In patients which ascending aortic surgery was performed, total circulatory arrest (TCA) for open distal anastomosis was applied (18 °C) [Kaplan 2015]. Topical cooling was not performed in any of the operations.…”

Section: Operative Techniquementioning

confidence: 99%

Open Cardiac Surgery without Blood and Blood Products Transplantation

Kaplan

Can

Karaagac

et al. 2017

HSF

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We have performed a total of 138 cases; no blood and blood products were transfused in 71% (n = 98), and in 29.0% (n = 40) blood and blood products were transfused. Thirty-day mortality and morbidity (arrhythmia, infectious and pulmonary morbidity, myocardial infarction, cerebrovascular accident, renal dysfunction, sternal revision) were compared between these two groups and no statistically significant difference was observed. Patients' awakening, extubation time, cardiopulmonary bypass period, cross-clamp time, and days in intensive care unit and hospital were compared, and there was no statistically significant difference between the two groups. Conclusion: In this study, we conclude that open heart surgery without blood transfusion may be accomplished with decent peri/postoperative management. The patients who did not receive any blood or blood products were not compromised clinically or hemodynamically. No extra morbidity and mortality were seen in the non-transfusion group. Transfusion decision was based on clinical and hemodynamic parameters such as persistent hypotension or tachycardia, hyperlactatemia, low urine output, and anemic symptoms.

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“…As a consequence, the remaining aneurysmatic tissue may predispose patients to a further arch dilatation with aneurysm formation on the long run. On the other hand, “open” distal anastomosis and hemiarch reconstruction in hypothermic circulatory arrest (HCA) allows a more complete resection of aneurysmatic tissue [ 3 , 4 , 5 ]. However, the use of HCA results in prolonged extracorporeal circulation with potential end organ ischemia.…”

Section: Introductionmentioning

confidence: 99%

Transversal Arch Clamping for Complete Resection of Aneurysms of the Distal Ascending Aorta without Open Anastomosis

Rukosujew

Motekallemi

Wisniewski

et al. 2022

JCM

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Background: The extent of aortic replacement for aneurysms of the distal ascending aorta remains controversial and opinions vary between standard cross-clamp resection and open hemiarch anastomosis in circulatory arrest and selective cerebral perfusion. As the deleterious effects of extended circulatory arrest are well-known, borderline indication for distal ascending aorta aneurysm repair must be outweighed against the potential risk of complications related to the open anastomosis. In the present study, we describe our own approach consisting of “transversal arch clamping” for exhaustive resection of aneurysms of the distal ascending aorta without open anastomosis and we present the postoperative outcomes. Methods: Between May 2017 and December 2019, 35 patients with aneurysm of the ascending aorta (20 male, 15 female) underwent replacement with repair of the lesser curvature without circulatory arrest. Pre-operative, intraoperative, and postoperative clinical outcomes were retrospectively withdrawn from our institutional database and analyzed. Results: Maximal diameter of distal ascending aorta was 47.5 mm. Patient median age was 66 years (IQR 14) (range 42–86). Preoperative logistic median EuroSCORE II was 17% (IQR 11.3). Median duration of cardiopulmonary bypass and cardiac arrest were 137 (IQR 64) and 93 (IQR 59) min, respectively. In-hospital and 30-day mortality were 0%. There were no cases with acute low output syndrome, surgical re-exploration for bleeding, kidney injury requiring dialysis, or wound infection. Disabling stroke was observed in one patient (2.9%). There was one case of major ventricular arrhythmia (2.9%). Conclusions: Our institutional experience suggests that this novel technique is safe and feasible. It facilitates complete resection of the aortic ascending aneurysm avoiding circulatory arrest, antegrade cerebral perfusion, additional peripheral cannulation, and all related complications.

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Open Distal Anastomosis Technique for Ascending Aortic Aneurysm Repair without Cerebral Perfusion

Cited by 3 publications

References 0 publications

A New Surgical Approach for Aortic Root Aneurysm and Small Aortic Annulus

A New Surgical Approach for Aortic Root Aneurysm and Small Aortic Annulus

Open Cardiac Surgery without Blood and Blood Products Transplantation

Transversal Arch Clamping for Complete Resection of Aneurysms of the Distal Ascending Aorta without Open Anastomosis

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