title: An improved isolation technique for shaggy brachiocephalic artery and aortic arch replacement.
abstract: A mobile plaque in the ascending and transverse aorta increases the risk of cerebral infarction during treatment of an arch aneurysm. A previous report described an isolation technique for replacing the ascending and transverse aorta with a mobile atheroma by selective hypothermic antegrade cerebral perfusion (Shiiya et al., Ann Thorac Surg 72:1401-1402, 2001). Here, we present an improved isolation technique for more severe conditions, such as shaggy aorta and shaggy brachiocephalic artery, in two patients. First, we anastomosed both axillae arteries with grafts and placed drainage cannulae in the superior and inferior venae cavae prior to filling the cardio-pulmonary bypass system with blood. Next, we cannulated the right common carotid artery and selective cerebral perfusion was started prior to cannulation and perfusion of the left common carotid artery. Systemic perfusion was then initiated through the axillae grafts. Both patients who underwent this procedure recovered without neurologic complications.
authors.affiliation: Department of Cardiovascular Surgery, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan, sawamasa7007bb@nifty.com.
authors.forename: Masaru
authors.initials: M
authors.lastname: Sawazaki
authors.forename: Shiro
authors.initials: S
authors.lastname: Tomari
authors.forename: Kenta
authors.initials: K
authors.lastname: Zaikokuji
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Imaeda
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001366:Axillary Artery / Q000601:surgery*; D016122:Brachiocephalic Trunk / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods; D017536:Carotid Artery, Common / Q000601:surgery; D002404:Catheterization / Q000379:methods; D002544:Cerebral Infarction / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000601:surgery; D061205:Vascular Calcification / Q000601:surgery; D014682:Vena Cava, Inferior / Q000601:surgery; D014683:Vena Cava, Superior / Q000601:surgery
references.citation: J Thorac Cardiovasc Surg. 2013 Mar;145(3 Suppl):S191-6
references.pmid: 23260457
references.citation: Ann Thorac Surg. 2001 Oct;72(4):1401-2
references.pmid: 11603483
references.citation: Ann Thorac Surg. 2005 Apr;79(4):1422-4
references.pmid: 15797103
references.citation: Gen Thorac Cardiovasc Surg. 2013 Apr;61(4):191-6
references.pmid: 23086588
references.citation: Rev Bras Cir Cardiovasc. 2008 Jan-Mar;23(1):70-7
references.pmid: 18719831
references.citation: Thorac Cardiovasc Surg. 2010 Aug;58(5):276-9
references.pmid: 20680903
references.citation: Am Heart J. 1999 Oct;138(4 Pt 1):746-52
references.pmid: 10502222
references.citation: J Thorac Cardiovasc Surg. 2013 Mar;145(3 Suppl):S63-71
references.pmid: 23266252