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

[tdmartin2000 at aol.com]

Roberto
Interesting case and sounds like a great result. I am a little confused on why you needed to perfuse proximally. We had a similar case yesterday on a 40 yo pt who had a coarc repaired by Dr Cooley 30yrs ago with a dacron patch that presented with a 8 cm distal arch/DTAA. Using a similar approach we used fem-fem bypass, cooled to 18 deg centigade, clamped the distal descending to allow continuous perfusion of the lower body and resected the arch from the left carotid to T7. Our first anastomosis was to the underside of the arch at the carotid level. By perfusing distally you keep the heart full and virtually have no air in the heart or ascending. As soon as the anastomosis was done, we cannulated the graft proximally (just distal to the anastomosis), deaired the graft, clamped distal to the cannula and started reperfusing proximally (cerebral/cardiac ischemia - 18 min). We then replaced his descending to T7.
Cannulation via the apex is a good technique when needed but I have seen some cardiac apices fall apart, so I try to stay away from it unless really necessary.

Tom Martin
U of Florida
Gainesville


-----Original Message-----
From: Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>
To: OpenHeart-L at lists.hsforum.com
Sent: Fri, 3 Aug 2007 11:22 am
Subject: AW: [HSF] Descending Aorta aneurysmectomy after operated Type A Dissection- Perfusion through the ventricle.




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

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