title: [Aortic arch reconstruction without aortic cross-clamping using separate extracorporeal circulation].
abstract: Between March 1991 and October 1992, 21 consecutive patients underwent aortic arch reconstruction without aortic cross-clamping using separate extracorporeal circulation in combination with retrograde blood cardioplegia (Non-clamping selective cerebral perfusion). Twelve patients had true arch aneurysm, 3 had acute aortic dissection and 6 had chronic aortic dissection including 2 redo cases. Cardiopulmonary bypass (CPB) was instituted with an arterial cannula in the femoral artery and 2 cannulae in both vena cavae. When tympanum temperature was lowered to 20 degrees C by central cooling, CBP was stopped temporarily. As soon as the aortic arch was incised longitudinally together with aneurysm, flexible 12 Fr. balloon cannulae were inserted into the three arch arteries via their orifices and selective cerebral perfusion was started. The perfusion flow was kept between 0.3 L/m2/min and 0.35 L/m2/min with the pressure of catheter tip from 30 to 60 mmHg to keep tympanum temperature 18 degrees C. Heart was protected by retrograde continuous cold blood cardioplegia. During arch correction, the descending aorta was occluded by a balloon then abdominal viscera were perfused via a femoral return cannula and rewarming to 25 degrees C was started to prevent visceral organ failure and coagulopathy. The time of separate perfusion ranged 20 to 161 minutes with a mean of 99.9 minutes. Except one patient who died of pneumonia, 20 patient (95.2%) were discharged and doing well. No cerebral complication, myocardial infarction, lung bleeding and coagulopathy occurred. In order to prevent the infarction by debris and to protect vital organs, this method is reliable for aortic arch reconstruction.
authors.affiliation: Division of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ogawa
authors.forename: T
authors.initials: T
authors.lastname: Higami
authors.forename: T
authors.initials: T
authors.lastname: Asada
authors.forename: N
authors.initials: N
authors.lastname: Mukohara
authors.forename: H
authors.initials: H
authors.lastname: Obo
authors.forename: T
authors.initials: T
authors.lastname: Sugimoto
authors.forename: M
authors.initials: M
authors.lastname: Nakamura
authors.forename: E
authors.initials: E
authors.lastname: Wakiyama
authors.forename: T
authors.initials: T
authors.lastname: Kawamura
authors.forename: M
authors.initials: M
authors.lastname: Nishiwaki
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002544:Cerebral Infarction / Q000517:prevention & control; D003250:Constriction; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D008875:Middle Aged