Document Detail

Non clamping anastomosis of the ascending and arch aneurysm using retrograde cerebral perfusion.
MedLine Citation:
PMID:  9023457     Owner:  NLM     Status:  MEDLINE    
Twelve consecutive patients requiring surgery for replacement of ascending aortic aneurysms (n = 3), ascending arch aortic aneurysms (n = 2), or type A aortic dissections (n = 7) were treated without aortic cross clamping. Retrograde cerebral perfusion (RCP) with circulatory arrest (mean RCP time: 46.0 +/- 15.9 minutes, range 20 to 65 minutes) and continuous retrograde cardioplegia (mean cardiac ischemic time: 134.4 +/- 39.7 minutes, range: 40 to 180 minutes) were employed. In the patients with aortic dissection, the intimal tear at the origin of the brachiocephalic artery (BCA) was resected completely, the aortic wall was trimmed and closed with Teflon felt. The distal anastomosis was created using an open technique. Air and debris were completely evacuated by returning blood from the cerebral vessels and femoral artery. Then the artificial graft was clamped, and cardiopulmonary bypass resumed. The proximal anastomosis was performed during rewarming. The operations were elective in seven cases, and emergent in five cases. Graft replacement of the ascending aorta was performed in ten patients (including two BCA reconstructions). The remaining two patients were treated by patch repair (n = 1), primary anastomosis (n = 1). There were no perioperative deaths. One patient had a transient neurological deficit. The distal false lumen was occluded completely in five of seven patients with aortic dissections. The other two patients had a secondary tears in the descending aorta. Thus retrograde cerebral perfusion and continuous retrograde cardioplegia without aortic cross clamping is an effective technique in the replacement of the ascending and arch aorta.
C Yamashita; H Yoshimura; T Azami; H Wakiyama; K Nakagiri; S Tobe; K Ataka; H Nakamura; M Okada
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Kobe journal of medical sciences     Volume:  42     ISSN:  0023-2513     ISO Abbreviation:  Kobe J Med Sci     Publication Date:  1996 Aug 
Date Detail:
Created Date:  1997-03-13     Completed Date:  1997-03-13     Revised Date:  2008-04-08    
Medline Journal Info:
Nlm Unique ID:  0413531     Medline TA:  Kobe J Med Sci     Country:  JAPAN    
Other Details:
Languages:  eng     Pagination:  261-70     Citation Subset:  IM    
Department of Surgery, Kobe University School of Medicine.
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MeSH Terms
Anastomosis, Surgical / methods
Aneurysm, Dissecting / pathology,  surgery*
Aorta / pathology,  surgery
Aortic Aneurysm, Thoracic / pathology,  surgery*
Heart Arrest, Induced / methods*
Middle Aged
Perfusion / methods*
Treatment Outcome

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