Reoperation for a giant arch anastomotic pseudoaneurysm eleven years after total arch replacement with island reconstruction

Abstract

BackgroundThe long-term effects of some surgical treatment procedures of arch replacement for aortic dissection or aortic aneurysm are unknown.Case presentationThe present study reports the case of a 68-year-old man admitted to our hospital for aortic arch anastomotic pseudoaneurysm with concomitant aortic root enlargement and coronary artery stenosis. Eleven years ago, at the age of 56 years, he underwent total arch replacement with island reconstruction for chronic aortic dissection. We performed a second total arch replacement, aortic root replacement, and coronary artery bypass, using a cardiopulmonary bypass with cannulation through the right subclavian artery, femoral artery, and femoral vein prior to re-sternotomy. We also used selective cerebral perfusion. Postoperatively, the patient temporarily required reintubation; however, he was discharged in good condition on the fiftieth postoperative day.ConclusionsThis case suggests that island reconstruction has the potential to cause arch anastomotic pseudoaneurysms, particularly after a long postoperative period.

A surgical technique for ascending aorta, aortic arch and descending aorta replacement without cross-clamp, circulatory arrest or hypothermia

“…Surgery usually requires aortic cross-clamping, cardiac arrest and even deep hypothermia for a bloodless comfortable field for the critically important anastomosis of the arch vessel and the distal aorta. 2 Meanwhile cerebral protection has utmost importance during the procedure and various attempts including total circulatory arrest, antegrade, or retrograde cerebral perfusion methods have been defined and well-studied in the literature. 3 Advantages of continuous cerebral perfusion over hypothermic deep circulatory arrest have been shown in the literature.…”