Journal of cardiac surgery
-
The problem of altered hemostasis remains a major challenge during thoracic aortic surgery. Bleeding is associated with a marked increase in morbidity and mortality. The hemostatic derangements are caused by multiple interrelated factors including interference with the vascular integrity, extensive surgical dissection, transient need for complete inhibition of the normal coagulation process, large blood products and fluid requirements, hemodilution, hypothermia, extensive ischemia and reperfusion, activation of systemic inflammatory responses, interference with fibrinolysis, and the use of extracorporeal circulation systems. ⋯ Rewarming may produce clear procoagulant effects by improving the efficacy of platelets and clotting factors. Platelet dysfunction can be reduced by several pharmacological interventions including acid aminocaproic, desmopressin and aprotinin; however, efficacy and safety are still being established. The most important factorS regarding safety in thoracic aortic surgery are a secure suture line and the experience of the surgical and anesthesiology teams.
-
We currently routinely use profound hypothermic circulatory arrest (PHCA) with retrograde cerebral perfusion (RCP) during repair of proximal aortic dissection and aneurysms involving the transverse aortic arch. Experimental data regarding the efficacy of RCP are conflicting. We retrospectively reviewed our experience with proximal aortic surgery to compare the results of PHCA performed with and without RCP. ⋯ Patients who had RCP during PHCA had lower mortality and stroke rates than those who did not. Although the higher prevalence of cerebrovascular disease, diabetes, and dissection in the latter group may have contributed to these differences, the clinical results confirm the safety and potential benefits of RCP, further supporting its use during proximal aortic surgery requiring circulatory arrest.
-
Until recently the surgical treatment of aneurysms of the aortic root in patients with the Marfan syndrome consisted of composite replacement of the aortic valve and ascending aorta. At the present, almost one-half of these patients can have reconstruction of the aortic root with preservation of the aortic valve. The mitral valve can also be frequently preserved. ⋯ Although the number of patients in each group is small and the follow-up relatively short, aortic valve-sparing operations have given gratifying results and may prove superior to valve replacement in patients with the Marfan syndrome.