title: Simultaneous insertion of a left ventricular assist system and repair of an ascending aortic dissection.
abstract: Operative methods for repairing ascending aortic dissections and for implanting left ventricular assist systems have been thoroughly presented in the medical literature. Only a few reports, however, describe the concomitant performance of these procedures in 1 patient. We report the repair of an acute ascending aortic dissection with simultaneous placement of a long-term left ventricular assist system. One week earlier, the patient had undergone emergent coronary artery bypass grafting and short-term postcardiotomy ventricular assistance when he could not be weaned from cardiopulmonary bypass. By creating a graft-to-graft anastomosis on the bench during cooling of the patient on cardiopulmonary bypass, we were able to shorten to 21 minutes the period of hypothermic circulatory arrest required during ascending aortic dissection repair. The procedures were completed successfully. However, the patient developed pneumonia and sepsis during his extended hospital stay and died of multiorgan failure 5 weeks postoperatively.
authors.affiliation: Department of Cardiac Transplantation, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA. igregoric@heart.thi.tmc.edu
authors.forename: Igor D
authors.initials: ID
authors.lastname: Gregoric
authors.forename: Nanthini
authors.initials: N
authors.lastname: Palanichamy
authors.forename: Saverio
authors.initials: S
authors.lastname: La Francesca
authors.forename: Ron D
authors.initials: RD
authors.lastname: Smith
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Myers
mesh_terms: D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D017809:Fatal Outcome; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D019919:Prosthesis Implantation / Q000379:methods*; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery*