Surgical Treatment with Extracorporeal Circulation for Acute Dissection of Descending Thoracic Aorta.
- Author:
Jong Bum CHUI
1
;
Hae Dong JUNG
;
Hyun Woong YANG
;
Sam Yoon LEE
;
Soon Ho CHOI
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Wonkwang University School of Medicine, Iksan, Jeonbuk, Korea.
- Publication Type:Original Article
- Keywords:
Aorta;
descending;
Dissection;
acute;
Surgery method;
Cardiopulmonary bypass
- MeSH:
Aorta;
Aorta, Thoracic*;
Atherosclerosis;
Cardiopulmonary Bypass;
Catheters;
Extracorporeal Circulation*;
Heart Atria;
Humans;
Lung Abscess;
Neurologic Manifestations;
Perfusion;
Postoperative Complications;
Respiratory Distress Syndrome, Adult;
Retrospective Studies;
Spinal Cord;
Transplants;
Vena Cava, Inferior
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
1998;31(5):481-487
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
The surgical management of acute type B dissection is controversial. The complexity of the repair usually requires a period of aortic cross-clamping exceeding 30 minutes, which can cause ischemic injury of the spinal cord. Several forms of distal perfusion have been considered for use to prevent this injury. To determine the safety and efficacy of a graft replacement with cardiopulmonary bypass in reparing acute dissection of descending thoracic aorta, we retrospectively reviewed our surgical experience treating 8 patients who had aortic dissection secondary to atherosclerosis, trauma, and carcinoma invasion. Cardiopulmonary bypass was performed with two aortic cannulas for simultaneous perfusion of the upper and lower body and one venous cannula for draining venous blood from the right atrium or inferior vena cava. Although aortic cross-clamp time was relatively long (average, 117.8 minutes; range, 47 to 180 minutes) in all cases, there was no neurologic deficit immediately after graft replacement for the aortic lesion. Two patients (25%) of relatively old age died on the postoperative 31st and 41st days, respectively, because of delayed postoperative complications, such as pulmonary abscess and adult respiratory distress syndrome. Although any of several maneuvers may be appropriate in managing dissection of the descending aorta, graft replacement with cardiopulmonary bypass during aortic cross-clamping may be a safe and effective method for the treatment of acute dissection of the descending thoracic aorta.
