AW: [HSF] Descending Aorta aneurysmectomy after operated Type A Dissection- Perfusion through the ventricle.

[Dr. Roberto Battellini]

For aortic surgery lovers:
I want to comment a case we did 2 days ago with our master and friend, Fred
Mohr. 
The patient, born in 1937, got 2 years ago an ascending and partial arch
resection for Type A dissection. The distal aorta remained dissected and
grew up to 6 cm. The aorta was very wide until the diaphragm. 

Elective operation:  Left lateral thoracotomy cutting the condrocostal union
and diaphragm in circular art.(I prepare all this cases)
The left femoral artery and vein were first cannulated, with a Y connector.
First, perfusion at 32 degrees centigrades. Vent in the ventricle apex.
Distal Aortic clamping at the diaphragm level, and anastomosis with a 24
Dacron Haemashield, on the beating heart just over the truncus coeliacus.

Then,clamping the distal prosthesis, continuing the perfusion to 24 degrees,
and perfusing proximally (antegradelly) through the left ventricle apex.
At 24 degrees, stop the proximal perfusion, and resection of the distal
arch, leaving the origin of the great vessels. Proximal anastomosis under
DHCA, 16 minutes. Continuing after the perfusion through the ventricle, this
is very interesting because it allows to deair!!! Then, clamping the
proximal prosthesis, for later anastomosis with the distal one.
In the thoracic aorta 2 pairs of intercostal arteries were reimplanted. 

Patient awake, neurologically ok, she was 2 days at ICU. 

We have done several of this cases, now are doing this ventricular
perfusion, very nice for deairing.

Roberto