Special cerebral perfusion in surgery for the ruptured thoracic aortic aneurysm.
BACKGROUND
For surgical treatment of the ruptured thoracic aortic aneurysm (TAA), it is important to control bleeding and to protect the brain, spinal cord, and myocardium. We have developed and performed a new procedure on 6 patients with a ruptured TAA, a true aneurysm in 3 patients and a type A dissection in the other 3.


METHODS
Cardiopulmonary bypass is installed with cannulations to the iliac artery and vein and to the common carotid arteries on both sides of the neck before the sternum is divided. For control of bleeding, venous drainage is accelerated, whereas cerebral perfusion is maintained via the carotid arteries. After insertion of the occlusion catheters into the descending aorta and the left subclavian artery following the aortotomy, the bypass flow to the iliac artery is increased.


RESULTS
The arch replacement was performed in 4 patients and hemiarch replacement in two. Five patients are alive without neurologic deficits; one patient died of multi-organ failure on the 24th postoperative day.


CONCLUSIONS
We conclude that our procedure may be advantageous for patients with a ruptured TAA, a large retrosternal aneurysm, or reoperation of the thoracic aorta.
Moro
H
H
Second Department of Surgery, Niigata University School of Medicine, Niigata City, Japan.
Hayashi
J I
JI
Ohzeki
H
H
Sogawa
M
M
Nakayama
T
T
Hirahara
H
H
D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002545:Brain Ischemia / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged