Abstract
The results of graft replacement for aneurysms involving the entire transverse aortic arch have lagged far behind that achieved for similar lesions located elsewhere. For example, prior to the study reported here, the mortality rate of the former, in our experience, was 25%, whereas it was only 8% for the most extensive forms of thoracoabdominal aortic aneurysms. The difference had been due to limitations and complications of methods employed for cerebral and myocardial protection. The high mortality rate in our patients was due to the deficiencies of temporary bypass graft and cardiopulmonary bypass, and separate brachiocephalic perfusion employed for this purpose. This report is concerned with the use of profound hypothermia for cerebral protection and the application of graft inclusion and direct brachiocephalic arterial reattachment to prevent bleeding in region of operation, as so successfully employed in patients with thoracoabdominal aortic aneurysms. The entire thoracic aorta was involved in four patients, the aortic valve in two patients, coronary artery bypass was performed in two patients, and the pulmonary artery was obstructed in one patient. Employing the techniques described in this report, all eight patients with these extensive lesions survived without complication.
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- Bentall H., De Bono A. A technique for complete replacement of the ascending aorta. Thorax. 1968 Jul;23(4):338–339. doi: 10.1136/thx.23.4.338. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Crawford E. S., Saleh S. A., Schuessler J. S. Treatment of aneurysm of transverse aortic arch. J Thorac Cardiovasc Surg. 1979 Sep;78(3):383–393. [PubMed] [Google Scholar]
- Crawford E. S., Snyder D. M., Cho G. C., Roehm J. O., Jr Progress in treatment of thoracoabdominal and abdominal aortic aneurysms involving celiac, superior mesenteric, and renal arteries. Ann Surg. 1978 Sep;188(3):404–422. doi: 10.1097/00000658-197809000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Crawford E. S., Walker H. S., 3rd, Saleh S. A., Normann N. A. Graft replacement of aneurysm in descending thoracic aorta: results without bypass or shunting. Surgery. 1981 Jan;89(1):73–85. [PubMed] [Google Scholar]
- Edwards W. S., Kerr A. R. A safer technique for replacement of the entire ascending aorta and aortic valve. J Thorac Cardiovasc Surg. 1970 Jun;59(6):837–839. [PubMed] [Google Scholar]
- Ergin M. A., Griepp R. B. Progress in treatment of aneurysms of the aortic arch. World J Surg. 1980 Sep;4(5):535–542. doi: 10.1007/BF02401623. [DOI] [PubMed] [Google Scholar]
- Griepp R. B., Stinson E. B., Hollingsworth J. F., Buehler D. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg. 1975 Dec;70(6):1051–1063. [PubMed] [Google Scholar]
- JAVID H., JULIAN O. C., DYE W. S., HUNTER J. A. Complications of abdominal aortic grafts. Arch Surg. 1962 Oct;85:650–662. doi: 10.1001/archsurg.1962.01310040122014. [DOI] [PubMed] [Google Scholar]
- Kouchoukos N. T., Karp R. B., Lell W. A. Replacement of the ascending aorta and aortic valve with a composite graft: results in 25 patients. Ann Thorac Surg. 1977 Aug;24(2):140–148. doi: 10.1016/s0003-4975(10)63723-x. [DOI] [PubMed] [Google Scholar]
- Lefrak E. A., Howell J. F. Successful surgical management of acute retrograde dissection of the aorta during coronary artery bypass. J Thorac Cardiovasc Surg. 1972 Jan;63(1):149–153. [PubMed] [Google Scholar]