Dual inflow without circulatory arrest for hemiarch replacement
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(2019) 14:9
CASE REPORT
Open Access
Dual inflow without circulatory arrest for hemiarch replacement Tae Yun Kim1* and Kyung Hwa Kim1,2
Abstract Background: Open distal graft to proximal aortic arch anastomosis is central to a hemiarch replacement. Even if the ischemic tolerance time of several organs during circulatory arrest (CA) at normothermia is much longer than that of the brain, very little is known about the safety and clinical efficacy of moderate hypothermia for organ protection during the average duration of CA needed for aortic arch replacement. Hemiarch replacement using the standard techniques of deep hypothermia and antegrade perfusion has often ignored the effects of prolonged distal body CA. Maintenance of distal organ, especially the liver and kidney, perfusion reduces the risk of postoperative renal dysfunction and coagulopathy. Case presentation: A 72-year-old female patient was referred to our institute due to chest discomfort. Radiologic investigations revealed a giant aneurysm of the ascending aorta extending but confined to the proximal aortic arch. We performed an alternative technique for hemiarch replacement using a dual inflow source. Conclusions: Although this technique cannot apply to all aneurysmal aortic diseases, our basic technique involving the use of dual inflow may be well suited for standard hemiarch replacement that is confined to the proximal aortic arch, given the shortening of the bypass and ischemic times. Keywords: Dual inflow, Hemiarch replacement, No circulatory arrest
Background Although the use of selective antegrade cerebral perfusion (SACP) during circulatory arrest (CA) has allowed aortic arch repair to be performed safely with moderate hypothermic CA [1], the susceptibility of the distal organ to ischemia often has been ignored during CA [2]. In particular, visceral organ injury cannot be guaranteed during moderate hypothermic CA when cerebral perfusion is used alone. We present an alternative technique for hemiarch replacement using a dual inflow strategy that does not require deep hypothermic CA.
Case presentation A 72-year-old female patient was referred to our institute due to chest discomfort. The radiologic investigations revealed a giant aneurysm of the ascending aorta, extending but confined to the proximal aortic arch and 7.5 cm in size (Fig. 1). We performed a median sternotomy with initial arterial cannulation of the right axillary artery using an 8 mm vascular graft and the right femoral artery for a second arterial line with a Y-limb preparing the circuit. The arm of the circuit going to the femoral artery was clamped. A two-stage venous cannula was inserted into the right atrium. The bypass was initiated via the right axillary arterial line and systemic cooling was applied to reach a bladder temperature of 32 °C. During cooling, vessel loops
* Correspondence: [email protected] 1 Department of Thoracic and Cardiovascular Surgery, Chonbuk, National University Medical School, Chonbuk National University Hospital, 20 Geonji-Ro, Geumam-dong, Deokjin-
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