[HSF] Aortic dissection

[tdmartin2000 at aol.com]

Ed

Sorry about your pt. We tried bioglue only for a while and seemed to get reasonable results, but we too had some problem of tearing at the suture line and others that came back with pseudoaneurysms. We have subsequently gone back to the tried and true felt inside and out with a little bioglue on the dacron needle holes. Endografts in dissections is really an unknown in terms of paralysis and longevity. I'll try to get our numbers together and post them. I really think we're creaping up on 50 plus.

Tom


-----Original Message-----
From: Edward Bender <ebender001 at charter.net>
To: OpenHeart-L at lists.hsforum.com
Sent: Sun, 23 Dec 2007 10:51 pm
Subject: Re: [HSF] Aortic dissection



Tom:?
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Thanks for your input.?
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Regarding how to do the movie: I captured single images (jpg's) in sequence from the hospital PACS system, then loaded them onto Apple Final Cut Pro with 0.5 second duration each. I rendered the sequence as a quicktime movie at various resolutions to get the best quality movie that would be allowed on the forum servers. It took about 15 minutes to do this. If anyone has any sequences they would like converted like this, I would be happy to make these.?
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Now, regarding the patient. I replaced his ascending aorta and arch, but, unfortunately, while closing him, he suddenly blew out the non-coronary sinus, and I couldn't get him back on bypass quick enough to prevent exsanguination and death. I was very pleased with the repair, but I apparently was just deluding myself. I have been avoiding felt strips, and just using bioglue in between the dissected layers, but maybe I should rethink this approach. Any thought or tricks would be appreciated.?
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I was planning on doing a thoracic stent graft as a second stage, but I was quite concerned about the previous aortic abdominal aneurysm graft and the risk of paraplegia. During a period of train of thought musings, I was wondering about a radical approach to these bad dissections, such as: graft from right axillary to femoral a, carotid-carotid bypass graft, then a stent graft from the sinotubular junction all the way around (assuming diameter was appropriate.?
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Ed Bender, MD?
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On Dec 23, 2007, at 9:30 PM, tdmartin2000 at aol.com wrote:?
?
> Great pics- howdid you do that??
> first, that is a bad dissection with the dissection going up into > the innom and the L subclavian.?I would probably consider some type > of debranching procedure at the first operation, replacing the > ascending and placing a bifurcated graft to the innom and L com > carotid with the prox portion of the graft coming off the very prox > portion of the ascending graft. That would leave you open to come > back and drop a stent graft all the way across the arch and down to > the celiac. We have now done about 40 or so dissections with stent > grafts with excellent results. Most of the time the false lumen > thromboses all the way down to the celiac. Some even have come back > a? yr later and you can't even tell they had?a dissection in the > descending.?
>?
> Tom Martin?
> U of Florida?
> Gainesville?
>?
> -----Original Message-----?
> From: Edward Bender <ebender001 at charter.net>?
> To: OpenHeart-L <OpenHeart-L at hsforum.com>?
> Sent: Sun, 23 Dec 2007 12:08 pm?
> Subject: [HSF] Aortic dissection?
>?
>?
> 64 year old male came to ER with resolved neck pain and numbness at > right side of mouth. He had undergone infra-renal abdominal aortic > aneurysm repair with a tube graft (open, not endograft) 6 months > previously at another hospital. His family said the surgeon told him > that he had other "problems" that they were going to watch for now. > Attached is the CTA sequence. After repair of the proximal portion > of this dissection, what would the aortic specialists recommend for > the downstream problems???
> ??
> Ed Bender, MD??
> ??
>?
>?
>?
>?
>?
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