Total replacement of the transverse aortic arch with the Gott aneurysm shunt.
A new method of temporary external shunting for total replacement of the aortic arch is described. Its greatest advantage is that systemic heparinization is not required. In a 46-year-old man total body perfusion was achieved with two 9-mm Gott aneurysm shunts inserted between the ascending aorta and both femoral arteries. Blood supply to the brain was maintained with the cut halves of a 7-mm Gott shunt connected as side branches to one of the 9-mm shunts, allowing cannulation of both carotid arteries. The total cardiac output, measured at 4.7 L/min by the thermodilution technique through a Swan-Ganz catheter, was propelled through these preheparinized multibranch shunts. A flowmeter adapted on one of the 9-mm Gott shunts demonstrated a shunt flow of 2000 ml/min and it was deduced that the other 2700 ml of the total cardiac output was delivered by the other shunt. During the 29 minutes of cross-clamping, there was no change in the filling pressure of either the right heart (central venous pressure 5 cm H2O) or the left heart (pulmonary wedge pressure 8 mm Hg). Aortic continuity was reestablished with the interposition of a 34-mm tubular woven Dacron prosthesis, on which two 10-mm woven Dacron side branches were anastomosed to the innominate and left common carotid arteries. The patient had no neurologic deficit and had normal physiologic function of all other organs.
Verdant
A
A
Department of Cardiovascular and Thoracic Surgery, Hôpital du Sacré-Coeur, Université de Montréal, PQ.
Pagé
A
A
Baillot
R
R
Lavoie
C
C
D000714:Anastomosis, Surgical / Q000295:instrumentation*; D001011:Aorta / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D016122:Brachiocephalic Trunk / Q000601:surgery; D002339:Carotid Arteries / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic