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[Operative Results of Total Arch Replacement with Arch First Technique using a Trifurcated Graft].
- Source :
-
Kyobu geka. The Japanese journal of thoracic surgery [Kyobu Geka] 2015 Mar; Vol. 68 (3), pp. 163-7; discussion 167-70. - Publication Year :
- 2015
-
Abstract
- In aortic arch surgery, we reconstruct branches before opening the arch to avoid cerebral embolism of the debris derived from the aortic wall. We made a trifurcated graft for branch reconstruction using 10 mm and 8 mm polyester grafts. Cardiopulmonary bypass started under right axillary perfusion and venous drainage through the right atrium. While cooling, the left subclavian artery was clamped and anastomosed to the end of the trifurcated graft. Then the ascending aorta was cross-clamped and cardioplegic solution was infused. At 25 degrees centigrade of the tympanic temperature, the left carotid artery is clamped and anastomosed to the branch of the trifurcated graft with or without perfusion into the left carotid artery. Subsequently the brachiocephalic artery was reconstructed in the same manner. After antegrade cerebral perfusion was established through the trifurcated graft via right axillary perfusion, distal anastomosis of the aortic arch was done with the open distal technique. Graft-graft anastomosis was followed to reperfuse the lower half of the body. Finally proximal anastomosis was performed to complete total arch replacement. Forty-four patients underwent total arch replacement in this technique. In-hospital mortality was 4.5%. Cerebral infarction occurred in 4.5% of the patients probably due to embolization of the debris derived from the branches of the aortic arch.
- Subjects :
- Adult
Aged
Aged, 80 and over
Anastomosis, Surgical
Brachiocephalic Trunk surgery
Cardiopulmonary Bypass
Constriction
Female
Humans
Intracranial Embolism prevention & control
Male
Middle Aged
Polyesters
Postoperative Complications prevention & control
Plastic Surgery Procedures methods
Subclavian Artery surgery
Treatment Outcome
Vascular Surgical Procedures methods
Aorta, Thoracic surgery
Aortic Aneurysm, Thoracic surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation methods
Subjects
Details
- Language :
- Japanese
- ISSN :
- 0021-5252
- Volume :
- 68
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Kyobu geka. The Japanese journal of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 25743547