Utility of the Isolation Technique for Total Arch Replacement in Patients with a Shaggy Aorta

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  • Kawase Takumi
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
  • Uehara Kyokun
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
  • Inoue Yosuke
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
  • Omura Atsushi
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
  • Seike Yoshimasa
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
  • Sasaki Hiroaki
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
  • Matsuda Hitoshi
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
  • Kobayashi Junjiro
    Department of Cardiovascular Surgery, National Cerebral and Cardiovascular

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  • 著明な粥状硬化を伴った弓部大動脈瘤に対する isolation 法を用いた弓部全置換術

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Abstract

<p>Introduction : Prevention of embolic stroke is the key issue to perform aortic arch replacement in patients with a shaggy aorta. The aim of this study is to report the utility of the isolation technique for total arch replacement in patients with a shaggy aorta. Methods : Clinical results of seven patients (71.7 years old, all men) with a shaggy aorta who underwent total arch replacement between January 2017 and November 2018 were retrospectively reviewed. The operative indications were a distal arch or proximal descending aortic aneurysm in 6 patients and a thrombus inside brachiocephalic artery in one. A cerebral perfusion was established by inserting a cannula directly into all supra-aortic branches before starting systemic perfusion. Result : Utilizing the isolation technique with clamping of all branches in 4 patients and the functional isolation technique with clamping of two branches in 3, total arch replacement was performed in all patients (operation time : 513 min, selective cerebral perfusion time : 162 min). No operative death was observed and no newly developed stroke was encountered. Conclusion : The isolation technique is a useful method to prevent stroke during total arch replacement in patients with a shaggy aorta.</p>

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