期刊
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
卷 29, 期 2, 页码 255-257出版社
ELSEVIER SCIENCE BV
DOI: 10.1016/j.ejcts.2005.10.040
关键词
aortic arch; aneurysm; aortic dissection; aortic surgery
A total of 120 patients having arch to distal arch aneurysm with downstream extension underwent total arch replacement, with individual arch-vessel reconstruction through median sternotomy using a novel 'stepwise' distal aortic anastomosis. Cardiopulmonary bypass was established by cannulating the right axillary artery and the ascending aorta or femoral. artery. Hypothermia was at 22-28 degrees C. Through the aneurysm, the descending aorta was divided. Distal anastomosis using the stepwise technique was performed; a tube graft of length 7-12 cm was inserted into the descending aorta and anastomosed by running suture. The distal end of the inserted graft was extracted, and a further four-branched arch graft was joined to it. Selective cerebral perfusion was used for cerebral safety during arch repair. There were three hospital deaths (2.5%). Two patients (1.7%) developed permanent neurological dysfunction and three patients (2.5%) suffered transient cerebral deficits. Three patients (2.5%) required reentry for postoperative bleeding although in none of them bleeding was from the distal anastomosis site with the stepwise technique. Stepwise anastomosis is a useful and secure alternative for distal anastomosis in total arch replacement for arch to distal. arch aneurysms with distal extension. (c) 2005 Elsevier B.V. All rights reserved.
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