Abstract
BackgroundAvoiding various complications is a challenge during re-do thoracoabdominal aneurysm surgery.Case presentationA 56-year-old man had undergone surgery for type I aortic dissection four times. The residual thoracoabdominal aortic aneurysm that had severe adhesions to lung parenchyma was resected. Since the proximal anastomotic site was buried in lung parenchyma, deep hypothermia was essential to avoid lung dissection and to protect the spinal cord during the proximal anastomosis. The deep hypothermia was induced with bilateral infusion of cardiopulmonary bypass by femoral artery cannulation for the lower body and by transapical cannulation for the upper body because of easy access. There was no hemorrhagic tendency after deep hypothermic bypass. The patient was discharged uneventfully.ConclusionsFor upper body perfusion, transapical aortic cannulation was a simple and effective procedure during left thoracotomy.
Highlights
Avoiding various complications is a challenge during re-do thoracoabdominal aneurysm surgery.Case presentation: A 56-year-old man had undergone surgery for type I aortic dissection four times
In thoracoabdominal aortic aneurysm (TAAA) surgery with severe lung adhesions caused by repeat operations, lung dissection followed by lung injuries causes postoperative respiratory failure
Deep hypothermic cardiopulmonary bypass (CPB) by transapical aortic cannulation might be useful in cases of a frequently operated, extended TAAA to avoid unnecessary dissection of the lung to find the proximal anastomosis and proximal aorta for cannulation
Summary
In thoracoabdominal aortic aneurysm (TAAA) surgery with severe lung adhesions caused by repeat operations, lung dissection followed by lung injuries causes postoperative respiratory failure. Transapical aortic cannulation is a novel and easy procedure for antegrade perfusion, and it could work for selective cardiac and cerebral perfusion by clamping the aorta distal to the left subclavian artery. Deep hypothermic CPB by transapical aortic cannulation might be useful in cases of a frequently operated, extended TAAA to avoid unnecessary dissection of the lung to find the proximal anastomosis and proximal aorta for cannulation. Case presentation The patient was a 56-year-old man who had undergone four surgical procedures for DeBakey type I dissection from 2002 to 2013: (1) graft replacement of the ascending aorta to the aortic arch (2002); (2) graft replacement of the proximal descending aorta to the Th7 level (2003); (3) Bentall operation (with a bioprosthetic valve) (2012); and (4) graft replacement of the infrarenal abdominal aorta to the bilateral external iliac arteries (2013).
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