A Reoperation for Pseudoaneurysm of the Proximal Anastomotic Site and Distal Enlargement of the Dissecting Arch and Descending Aorta after Ascending Aortic Replacement for Acute Type A Aortic Dissection
- VernacularTitle:急性 A 型大動脈解離に対する上行大動脈置換術後の中枢側吻合部仮性瘤および末梢側解離性大動脈拡大に対する再手術の1例
- Author:
Yuji Morishima
;
Katsuya Arakaki
;
Yukio Kuniyoshi
- Publication Type:Journal Article
- Keywords: acute aortic dissection; reoperation; median sternotomy with left anterolateral thoracotomy (Door open method); myocardial protection; antegrade continuous blood coronary perfusion
- From:Japanese Journal of Cardiovascular Surgery 2016;45(6):284-289
- CountryJapan
- Language:Japanese
-
Abstract:
We report a case of reoperation for proximal pseudoaneurysmal formation of the ascending aorta and distal enlargement of the dissecting arch and descending aorta after ascending aorta replacement for acute type A aortic dissection. The patient was a 47-year-old man who had undergone ascending aorta replacement and aortic valve replacement for acute type A aortic dissection three months previously. Pseudoaneurysm of the ascending aorta and enlargement of the dissecting arch and descending aorta were revealed by computed tomography. Therefore, we performed extensive replacement of the aortic root, arch and descending aorta. Median re-sternotomy with left anterolateral thoracotomy the (“Door open method”) was applied as the surgical approach. After reconstructing the aortic root using the modified Bentall procedure, we replaced the arch and descending aorta using antegrade continuous coronary perfusion with systemic blood through the composite graft of the aortic root under non-cardioplegic arrest. Despite the long duration of extracorporeal circulation, the duration of cardioplegic arrest was relatively short, and the postoperative cardiac function was not deteriorated at all. The patient is currently doing well with no problems at 1.5 years after the surgery. The Door open method was a useful approach providing good operative exposure in this case requiring extensive replacement of the thoracic aorta. Antegrade continuous blood coronary perfusion was useful for performing the arch and descending aortic replacement under non-cardioplegic arrest, and it was a reliable strategy for ensuring myocardial protection and avoiding prolonged duration of cardiac ischemia.