Successful Surgical Treatment of Thoracic Aortic Aneurysm in Two Patients with Old Cerebral Infarcts and Severely Stenotic Cerebral Vessels
10.4326/jjcvs.32.288
- VernacularTitle:高度脳血管障害を合併する胸部大動脈りゅう症例の治療経験
- Author:
Takahisa Okano
;
Shinichi Satoh
;
Keiichi Kanda
;
Yasuyuki Shimada
;
Hitoshi Yaku
;
Nobuo Kitamura
- Publication Type:Journal Article
- Keywords:
arch-first technique
- From:Japanese Journal of Cardiovascular Surgery
2003;32(5):288-292
- CountryJapan
- Language:Japanese
-
Abstract:
Our strategy for treatment of thoracic aortic aneurysms with severely stenotic or occluded cerebral vessels is as follows. 1) The status of cerebral vessels and brain is assessed in detail by a team of neurologists and neurosurgeons, 2) cerebral surgical treatment is performed prior to aortic arch surgery, and 3) reconstruction of the total arch is performed using the arch-first technique through a median sternotomy. We successfully performed artificial graft replacement of the total aortic arch in two patients with old cerebral infarcts and severely stenotic cerebral vessels. In both cases, the operation was performed through median sternotomy under circulatory arrest by feeding the blood to the ascending aorta and draining it from the right atrium. Cerebral protection during reconstruction of the aortic arch was provided by profound hypothermia and retrograde cerebral perfusion (RCP). Prior to the incision of the aneurysm, cerebral branches were dissected to avoid escape of debris into cerebral vessels. The graft replacement was completed in 4 steps: 1) anastomosis of each of the 3 arch vessels, 2) distal anastomosis of another graft for the elephant trunk procedure, 3) anastomosis of the arch graft and the graft for the elephant trunk, and 4) proximal anastomosis. Just after cerebral branches were anastomosed to the 3 branches of the graft, the blood was supplied to the brain through the side branch of the graft instead of RCP. No signs of neurological deficit occurred postoperatively. The above protocol provided protection of high-risk patients with old cerebral infarcts from possible postoperative brain damage.
