title: Total aortic arch replacement for a patient with poor left ventricular function and patent coronary artery bypass grafts: how to establish effective myocardial protection.
abstract: A 66-year-old man who had previously undergone coronary artery bypass grafting (CABG) was admitted to our institution for surgical treatment of a ruptured aortic arch aneurysm. He had three patent bypassed grafts including the left internal thoracic artery (LITA) to the left anterior descending artery (LAD), complicated by left ventricular dysfunction. Coronary angiography performed 1 year after the initial surgery revealed total occlusion of the LAD. In addition, the aneurysm was located next to the LITA; therefore, there was a significant risk of injury to the LITA during intraoperative dissection. For such a complicated and challenging case, we successfully performed a total aortic arch replacement using a Y-shaped composite saphenous vein graft (SVG) for the administration of cardioplegic solution to establish effective myocardial protection. This procedure, by which effective myocardial protection can be achieved, is a useful treatment option for aortic arch surgery after CABG with a patent LITA graft.
authors.affiliation: Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan. nippie550102@yahoo.co.jp
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nishigawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kubo
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yunoki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tabuchi
authors.forename: Hisao
authors.initials: H
authors.lastname: Masaki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tanemoto
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012501:Saphenous Vein / Q000503:physiopathology / Q000637:transplantation*; D013318:Stroke Volume; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D016277:Ventricular Function, Left