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- Title
Open aortic arch repair without circulatory arrest by frozen elephant trunk in Ishimaru zone 0.
- Authors
Bancone, Ciro; Della Corte, Alessandro; Lo Presti, Federica; Ashurov, Rasul; Sica, Giacomo; Palmieri, Lucrezia; Di Fraia, Rita; De Feo, Marisa
- Abstract
Background: Open arch surgery is technically demanding for the surgeon and surgically and biologically invasive for the patient, requiring a variably long period of hypothermic circulatory arrest. Case presentation: Here we present a case of an elderly patient with chronic renal failure and multiple splanchnic artery disease successfully treated for a rupturing pseudoaneurysm of the aortic arch with a technique that we developed for particularly frail patients. The procedure includes: triple supra-aortic vessel perfusion; distal thoracic aorta antegrade perfusion; balloon endo-clamping of the descending aorta; and anastomosis of an off-the-shelf hybrid arch prosthesis in Ishimaru zone 0. These maneuvers allowed to maintain an extracorporeal circulation in the phase of distal anastomosis, instead of a period of circulatory arrest, employing just mild hypothermia: technical details are depicted and discussed also in comparison with other methods proposed in the literature. Conclusions: Being able to take advantage of both open surgery advancements and endovascular methods is the key to cardiovascular surgery success today in front of complex pathologies of the aorta: increasing safety and reducing invasiveness of therapeutic options may progressively extend surgical candidacy to the frailest patients.
- Subjects
THORACIC aorta; ARTIFICIAL blood circulation; FALSE aneurysms; CHRONIC kidney failure; ARTERIAL diseases; RUPTURED aneurysms
- Publication
Journal of Cardiothoracic Surgery, 2024, Vol 19, Issue 1, p1
- ISSN
1749-8090
- Publication type
Article
- DOI
10.1186/s13019-024-02671-5