Reoperation for false aneurysm of the ascending aorta after its prosthetic replacement: surgical strategy.
BACKGROUND
This study analyzes surgical approaches of 29 operations carried out for false aneurysms of the ascending aorta after prosthetic replacement (FAA) from January 1979 to April 2003, in 28 patients.


METHODS
Initial operations consisted of a composite valve graft with reimplantation of coronary arteries (n = 14) or a supracoronary tube (n = 14) with 7 aortic valve replacements. Initial pathology included acute aortic dissection (n = 20), aortic annuloectasia (n = 6), and aortic valvulopathies with concomitant aneurysm of the ascending aorta (n = 2). Resternotomy was performed under the following conditions: femoral artery cannulation in 7, femoral artery and vein cannulation in 6, femoral artery, vein, and carotid artery cannulation in 16 patients of whom 6 patients underwent partial circulatory arrest. The FAA ruptured during sternotomy in 9 cases. Operative intervention consisted of direct simple suture repair (n = 7), complete revision (n = 21), and one isolated reimplantation of the coronary artery.


RESULTS
No patients died after FAA rupture during resternotomy. Among the 6 patients who underwent partial circulatory arrest before sternotomy, the FAA ruptured 5 times. Carotid artery cannulation was always justifiable: 2 cases of FAA rupture, 9 cases of aortic arch replacement, and 5 cases with both. The operative mortality was 17.2% (n = 5). Mortality was influenced by the emergent nature of operations (p < 0.05).


CONCLUSIONS
The FAA can be surgically managed with acceptable results through a sternotomy using prior femoro-femoral and carotid cannulation. The latter allows for cerebral perfusion in cases of FAA rupture during resternotomy and is of value for the surgical treatment of these complex lesions.
Mohammadi
Siamak
S
Department of Thoracic and Cardiovascular Surgery, Institute of Cardiology, La Pitié Hospital, Paris, France. siamakmohammadi@yahoo.com
Bonnet
Nicolas
N
Leprince
Pascal
P
Kolsi
Mohamed
M
Rama
Akhtar
A
Pavie
Alain
A
Gandjbakhch
Iradj
I
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D017541:Aneurysm, False / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001019:Aortic Rupture / Q000517:prevention & control; D001024:Aortic Valve Stenosis / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D002114:Calcinosis / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D002534:Hypoxia, Brain / Q000517:prevention & control; D007431:Intraoperative Complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence