The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Apr 2018
Is More than One Hour of Selective Antegrade Cerebral Perfusion in Moderate-to-Mild Systemic Hypothermic Circulatory Arrest for Surgery of Acute Type A Aortic Dissection Safe?
Surgery for acute type A aortic dissection (AAD) remains a surgical challenge with considerable risk of morbidity and mortality. Antegrade cerebral perfusion (ACP) has been popularized, offering a more physiologic method of brain perfusion during complex aortic arch repair, often necessary in setting of AAD. The safe limits of this approach under moderate-to-mild systemic hypothermic circulatory arrest (≥ 28°C) are yet to be defined. Thus, the current study investigates our clinical results after surgical treatment for AAD in patients with a selective ACP and systemic circulatory arrest time of ≥ 60 minutes in moderate-to-mild hypothermia (≥ 28°C). ⋯ Our preliminary data suggest that selective ACP during moderate-to-mild systemic hypothermic circulatory arrest (≥ 28°C) can safely be applied for more than 1 hour even in the setting of AAD.
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Thorac Cardiovasc Surg · Apr 2018
Case ReportsNo Clamp Complete Parachute Technique for Ascending Aorta Anastomosis in Hybrid Aortic Arch Debranching Surgery.
The proper proximal landing zone is a key element for success of endografting in thoracic aortic pathology. If coverage of innominate artery is unavoidable for safe proximal landing, arch debranching surgery is necessary to recruit supra-aortic blood flow before endografting. However, calcified or adhesive ascending aorta makes it difficult to clamp ascending aorta for anastomosis in the first step of arch debranching surgery. We present a novel "no clamp complete parachute technique" to complete this challenging anastomosis.