Transapical aortic perfusion using a deep hypothermic procedure to prevent dissecting lung injury during re-do thoracoabdominal aortic aneurysm surgery

• Published in: Journal of cardiothoracic surgery Vol. 12; no. 1; p. 32
• Main Authors: Kise, Yuya, Kuniyoshi, Yukio, Ando, Mizuki, Inafuku, Hitoshi, Nagano, Takaaki, Yamashiro, Satoshi
• Format: Journal Article
• Language: English
• Published: England BioMed Central 19.05.2017; BMC
• Subjects: Abdomen; Acute Lung Injury - prevention & control; Anastomosis; Aneurysm, Dissecting - diagnosis; Aneurysm, Dissecting - surgery; Aneurysms; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - diagnosis; Aortic Aneurysm, Thoracic - surgery; Aortic aneurysms; Blood Vessel Prosthesis Implantation - methods; Bypasses; Cannulation; Cardiovascular disease; Case Report; Complications; Computed Tomography Angiography; Cooling; Coronary vessels; Dissection; Femoral artery; Femur; Heart surgery; Hemorrhage; Humans; Hypothermia; Hypothermia, Induced - methods; Imaging, Three-Dimensional; Injuries; Injury prevention; Intraoperative Period; Lung injury; Lungs; Male; Middle Aged; Ostomy; Parenchyma; Perfusion; Perfusion - methods; Prostheses; Rope; Spinal cord; Surgery; Thoracoabdominal aortic aneurysm; Transapical aortic perfusion; Thoracoabdominal aortic aneurysm; Transapical aortic perfusion; Hypothermia; Lung injury
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-017-0601-9

Avoiding various complications is a challenge during re-do thoracoabdominal aneurysm surgery. A 56-year-old man had undergone surgery for type I aortic dissection four times. The residual thoracoabdominal aortic aneurysm that had severe adhesions to lung parenchyma was resected. Since the proximal anastomotic site was buried in lung parenchyma, deep hypothermia was essential to avoid lung dissection and to protect the spinal cord during the proximal anastomosis. The deep hypothermia was induced with bilateral infusion of cardiopulmonary bypass by femoral artery cannulation for the lower body and by transapical cannulation for the upper body because of easy access. There was no hemorrhagic tendency after deep hypothermic bypass. The patient was discharged uneventfully. For upper body perfusion, transapical aortic cannulation was a simple and effective procedure during left thoracotomy.