Transapical aortic perfusion using a deep hypothermic procedure to prevent dissecting lung injury during re-do thoracoabdominal aortic aneurysm surgery

Abstract

BackgroundAvoiding various complications is a challenge during re-do thoracoabdominal aneurysm surgery.Case presentationA 56-year-old man had undergone surgery for type I aortic dissection four times. The residual thoracoabdominal aortic aneurysm that had severe adhesions to lung parenchyma was resected. Since the proximal anastomotic site was buried in lung parenchyma, deep hypothermia was essential to avoid lung dissection and to protect the spinal cord during the proximal anastomosis. The deep hypothermia was induced with bilateral infusion of cardiopulmonary bypass by femoral artery cannulation for the lower body and by transapical cannulation for the upper body because of easy access. There was no hemorrhagic tendency after deep hypothermic bypass. The patient was discharged uneventfully.ConclusionsFor upper body perfusion, transapical aortic cannulation was a simple and effective procedure during left thoracotomy.

Direct Monitoring of Reconstructed Segmental Arterial Pressure during Deep Hypothermic Thoracoabdominal Aortic Aneurysm Surgery

“…Deep hypothermia could be essential to resolving these problems because perfusion would be unnecessary, providing sufficient time for SA reconstruction. 7,8) Application of MEPs is a useful method for intraoperatively evaluating spinal cord ischemia during normothermic or mildly hypothermic TAAA surgery. 1) However, because the amplitude of MEPs decreases and disappears in surgeries performed under deep hypothermia, spinal cord function after ischemia during aortic clamping cannot be assessed under those circumstances.…”

Simultaneous upper and lower body perfusion using hypothermia during thoracoabdominal aortic surgery

“…The general technique has been described previously [3,4]. After induction of anesthesia, a transcranial motor evoked potential (tcMEP) monitor was fitted, and the control values were measured.…”

“…When hypothermia is used, the proximal anastomosis is normally created under circulatory arrest [9,10], but we conduct simultaneous upper and lower body perfusion [3,4]. One reason is the concern that, under circulatory arrest, air and/or atheroma in the proximal anastomosis may embolize to the brain, an occurrence with a reported incidence of 4-9%.…”

“…The main reason is decreased spinal cord perfusion during aortic cross-clamping. With the aim of prolonging spinal cord ischemic tolerance time during cross-clamping, we use moderate to deep hypothermia and also conduct simultaneous upper and lower body perfusion [3,4]. The advantages of this method are that it not only maintains the blood supply to the spinal cord via the collateral network and protects the brain and heart, but it also enables the procedure to be conducted without lung damage even when the aortic crossclamping site is limited due to lung adhesions resulting from chronic dissection or in re-thoracotomy after thoracic descending aortic replacement.…”