title: Bilateral pulmonary endarterectomy and Bentall procedure completed in one surgical session.
abstract: We describe the performance, in one surgical session, of bilateral pulmonary endarterectomy and a button-technique Bentall operation in a 68-year-old man. The patient had chronic thromboembolic pulmonary hypertension and an ascending aortic aneurysm with moderate aortic regurgitation. The procedures were concurrently completed during short periods of systemic circulatory arrest, with antegrade cerebral perfusion maintained through the brachiocephalic artery at a flow rate of 10 mL/min/kg. The patient's cerebral perfusion was monitored with use of near-infrared spectroscopy, to prevent symmetric bilateral values from falling below 20% of the base value. The patient experienced no multiorgan failure or neurologic sequelae and, by the 6th postoperative day, improved from New York Heart Association functional class IV to class I.The reliable maintenance of continuous antegrade cerebral perfusion made the lengthy combined operation feasible, with low risk. The use of near-infrared spectroscopy enabled real-time monitoring of the patient's cerebral blood flow. Our experience shows the possibility of safely performing lengthy or multiple procedures in one surgical session.
authors.affiliation: Division of Cardiac Surgery, San Giovanni Battista Hospital Molinette, University of Torino, 10126 Torino, Italy. dricci@molinette.piemonte.it
authors.forename: Davide
authors.initials: D
authors.lastname: Ricci
authors.forename: Corrado
authors.initials: C
authors.lastname: Cavozza
authors.forename: Peppino
authors.initials: P
authors.lastname: Scoti
authors.forename: Domenico
authors.initials: D
authors.lastname: Mercogliano
authors.forename: Gaetano
authors.initials: G
authors.lastname: Minzioni
authors.forename: Dante
authors.initials: D
authors.lastname: Medici
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D004691:Endarterectomy; D065627:Familial Primary Pulmonary Hypertension; D006324:Heart Arrest, Induced; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007036:Hypothermia, Induced; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D010477:Perfusion / Q000379:methods; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D019265:Spectroscopy, Near-Infrared; D016896:Treatment Outcome
keywords: Brain ischemia/prevention & control; cardiac surgical procedures; endarterectomy/adverse effects/methods; hypertension, pulmonary/physiopathology/surgery; perfusion/methods; pulmonary artery/surgery; recovery of function; treatment outcome