[HSF] Aortic dissection and CPR

Thu Oct 4 21:53:43 EDT 2007

I have used a Sarns aortic arch cannula 24F. You could just as well use 
other straight cannulas 20 to 24 F. if they are 12 inches in length or 
so. I put it through the chest wall over the apex of the heart, 
otherwise it may kink in the pericardium. I do not put a purse string 
in the LV and repair the stab wound after the cannula has been removed 
still on bypass. John

-----Original Message-----
From: nand kejriwal <nkkejriwal at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 13 Sep 2007 5:43 am
Subject: Re: [HSF] Aortic dissection and CPR

We had two patients in the unit who arrested before reaching the OR. 
None of
them survived the repair. Recently, I had another case who arrested 
while
being transferred to theatre. He was intubated and CPR continued. My 
initial
plan was to establish bypass through femoral vessels while someone else 
was
massaging. However even external massage was not producing enough 
pressure
and this had been going on for over 10 minutes. TEE revealed pericardium
full of blood with empty heart. I did not proceed.

John

I agree that the quickest way to institute bypass would be transapical. 
What
cannula do you use?
Nand

On 9/11/07, jbflegejr at aol.com <jbflegejr at aol.com> wrote:
>
> I have had salvage of two patients who ruptured while on the operating
> table as they were prepared for anesthesia. They had not been induced
> completely but we opened there sternum anyway. One had femoral artery
> cannulation by a colleague, the other I cannulated through the
> ascending aorta as recently described by Curt Tribble. Both had no
> neurologic sequale. In one during the excitement I made the disal
> anastamosis a bit tight in effect causing an ascending aortic
> coarctation and he got hemoytic anemia from intraluminal felt and a
> year or so later I resected the area. If I encounter another case
> needing immediate cannulation, I will cannulate the ascending aorta
> through the LV apex which is quick and works well. I had another
> patient who presented in the ER in shock and with hyperacute ischemic
> ECG changes across the anterior leads. He had been worked up and a
> diagnosis of ascending  aortic aneurysm and aortic insufficiency and
> normal coronary arteries established and operation scheduled for the
> day after Christmas but he came back the day before Christmas and went
> straight to the OR. He had a Type A dissection extending into and
> obstructing the Left coronary. I replaced the ascending aorta which
> relieved the coronary obstruction and replaced the valve with a
> Starr-Edwards valve. This was 35 years ago. About 25 years post op he
> had a CT scan for some reason and the radiologist saw that he had an
> aortic dissection down to the femorals and got rather excited about it
> and sent me the films. I did not recommend treatment. In modern times
> this kind of patient would have an aortic root replacement. John Flege
>
>
> -----Original Message-----
> From: tdmartin2000 at aol.com
> To: OpenHeart-L at lists.hsforum.com
> Sent: Mon, 10 Sep 2007 9:06 pm
> Subject: Re: [HSF] Aortic dissection and CPR
>
>
>
>
>
>
> Most of these pts with sudden deterioration have rupture into their
> pericardium
> and are not salvageable. I have attempted on multiple occasions and
> have had 2
> that we got out of the OR only to have anoxic cerebral deaths. If they
> have
> tamponade, CPR does no good, as you cannot fill. One of the ones we 
got
> out of
> the OR actually had arrest right after induction of anesthesia and we
> were on
> pump in under 10 min.
>
>
>
> Tom Martin
>
> U of Florida
>
> Gainesville
>
>
> -----Original Message-----
> From: james le <jamesle2007 at yahoo.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Mon, 10 Sep 2007 6:35 am
> Subject: [HSF] Aortic dissection and CPR
>
>
>
>
> We recently had a   case of Aortic dissection   transferred from some
> other
> hospital for surgery. He had dissection   aorta involving the entire
> aorta along
>
> with severe AR.
>    On arrival BP   was 90 systolic, all pulses   palpable and   there
> was no
> neurological deficit
>    At ER he suddenly developed severe Bradycardia   and   arrested and
> resuscitation was unsuccessful. TEE done after death   showed only
> small amount
> of pericardial collection.
>
>     During CPR we had   a concern that vigorous massage could rupture
> aorta.
>   How can we salvage such patients?
>
>   Percutaneous bypass before we take to OR will help?
>
>
>
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