A surgical technique for ascending aorta, aortic arch and descending aorta replacement without cross-clamp, circulatory arrest or hypothermia

Uğurlucan, Murat; Yıldız, Yahya; Ulukan, Mustafa Özer; Öztaş, Didem Melis; Beyaz, Metin Onur; Canata, Emin; Coban, Senay; Ünal, Orçun; Erkanlı, Korhan; Türkoğlu, Halil

doi:10.1017/s1047951119003159

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…This prevents the potential risk of myocardial ischemia caused by coronary steal phenomenon [Alexi-Meskishvili 2011]. On the other hand, myocardial protection during surgical treatment has utmost importance [Ugurlucan 2020].…”

Section: E70mentioning

confidence: 99%

Current Strategies for the Management of Anomalous Origin of Coronary Arteries from the Pulmonary Artery

Beyaz

Coban

Ulukan

et al. 2021

HSF

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Introduction: The coronary arteries, which have to originate from the aorta, may sometimes rise from the pulmonary artery. This study evaluated clinical and diagnostic findings, treatment methods, and follow up of cases with anomalous coronary arteries arising from the pulmonary artery. Patients and methods: Eight patients with the diagnosis of anomalous left coronary artery from the pulmonary artery (ALCAPA) (N = 6) and anomalous right coronary artery from the pulmonary artery (ARCAPA) (N = 2), between January 2014 and January 2020 from a single center university hospital, were included in the study. Data from patients’ demographic characteristics, electrocardiography, echocardiography, angiographic findings, operation, hospitalization, and follow up were evaluated. Results: The study included eight patients (six females and two males) – six patients with ALCAPA and two with ARCAPA. The ages of the patients ranged between 3-135 (average: 53.25) months. The median body weight was calculated as 17.4 kg. Severe mitral valve insufficiency was detected in two patients and two other patients had a moderate degree of mitral insufficiency on echocardiography. Ejection fractions ranged between 16-74%. One patient had perimembranous malalignment large ventricular septal defect with pulmonary stenosis. Operative techniques were Takeuchi procedure (three patients), direct implantation (four patients), and left internal thoracic artery to left main coronary artery bypass (one patient). Mechanical cardiac support was not required in the postoperative period. Mortality did not occur. Mitral insufficiency and ejection fractions improved following correction of the coronary anatomy. Conclusion: It is important to diagnose the ALCAPA or ARCAPA, where the coronary artery originates from the pulmonary artery. Patients should be treated before congestive heart failure and fatal complications occur. Surgical correction should be planned regardless of symptom status, even though some of patients reach adulthood with an increased number of collaterals.

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Section: E70mentioning

confidence: 99%

Current Strategies for the Management of Anomalous Origin of Coronary Arteries from the Pulmonary Artery

Beyaz

Coban

Ulukan

et al. 2021

HSF

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“…We faced with pericardial roll dilatation in patients who received fresh tissues both of which presumed to result due to decreased strength of the material at the aortic position as well as additional proximal anastomosis stenosis in one (submitted elsewhere) who was further operated. 7 The remaining living patients are followed uneventful in good conditions devoid of significant stenosis of the used materials.…”

Section: Discussionmentioning

confidence: 99%

“…The size of the pericardial roll reached to 3.8 cm in diameter with echocardiography in one case, confirmed with CT revealing 4 cm in diameter (submitted elsewhere) with stenosis at the proximal ascending aortic anastomosis region of the pericardial roll. The patient underwent surgical restoration of the dilated pericardial roll by resection of the anterior enlarged segment and reconstruction including the ascending aorta with a xenograft patch with our on-pump beating-heart full-body perfusion technique, 7 uneventfully. The stenosis at the proximal anastomosis might have contributed to the aneurysm formation (i.e.…”

Section: Late Post-operativementioning

confidence: 99%

Off-pump ascending aorta or aortic arch to descending aorta bypass with a pericardial roll for the treatment of critically ill infants with interrupted aortic arch

et al. 2020

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Aim: Standard surgical treatment of the interrupted aortic arch with the use of cardiopulmonary bypass is risky especially in critically ill babies. In this manuscript, we present the results of off-pump pericardial roll bypass for the treatment of aortic interruption. Material and methods: The technique was applied in nine critically ill infants between July 2011 and December 2019. Data were reviewed retrospectively. There were four girls and five boys. The types of the interruption were type B in six cases and type A in three babies. Additional cardiovascular anomalies were ventricular septal defect in all, atrial septal defect or patent foramen ovale in all, single-ventricle pathologies in two and bicuspid aortic valve in three cases. All the patients were in critical situations such as intubated, having symptoms of infection, congestive heart failure or ischaemia and malperfusion leading visceral organ dysfunction. Results: All patients underwent off-pump ascending aorta or aortic arch to descending aorta bypass with a pericardial roll. Post-operative early mortality occurred in one patient with severe mitral regurgitation due to cardio-septic shock. One patient who had single-ventricle pathology underwent bidirectional Glenn and was lost on the post-operative 26th day due to sepsis 2 years after operation. Two patients presented with dilatation of the pericardial tube 18 and 24 months after the operations and one underwent reconstruction of the neo-arch. The remaining patients are asymptomatic, active and within normal limits of body and mental growth. Conclusion: Treatment of interrupted aortic arch with a bypass with an autologous pericardial roll treated with gluteraldehyde without cardiopulmonary bypass seems a safe and reliable technique especially for the treatment of critically ill infants.

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Aortik Kros Klemp ile Myokard İskemisi Yaratmadan Konjenital Düzeltilmiş Büyük Arter Transpozisyonlu Asendan Aortu Hipoplazik Tip A Kesintili Aortik Arkı Olan Hastanın Tedavisi

Oteyaka

2022

Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi

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İnterrupted aortik ark tedavisi karmaşık bir süreçtir. Cerrahi rekonstrüksiyon genellikle myokard iskemisine neden olan aortik kros klempleme, kalbin durdurulması ve hatta kansız operasyon sahası için derin hipotermi gerektirir.Bu yazıda, normotermik şartlarda, kalbi durdurmadan çıkan aort, aortik ark ve proksimal desendan aort replasmanını selektif kanülasyon ve tüm vücut perfüzyonunu sağlayan cerrahi teknik ile tedavi ettiğimiz konjenital düzeltilmiş büyük arter transpozisyonu, tip A kesintili aortik ark ve hipoplazik asendan aortu olan hastamızı sunuyoruz. Anahtar Kelimeler: Arkus aorta, Kesinti, Konjenital düzeltilmiş büyük arter transpozisyonu, Kanülasyon. ABSTRACT Treatment of interrupted aortic arch is complex. Surgical reconstruction consists of procedures that cause myocardial ischemia, such as aortic cross clamping, cardioplegia, and hypothermia. In this article, we present a patient with congenitally corrected transposition of great arteries together with Type A interruption as well as hypoplastic ascending aorta and the aortic arch. The replacement of the aorta, aortic arch, and the proximal descending aorta was performed under normothermic conditions without cardioplegia, which was achieved with a technique that preserves the systemic blood supply by using selective cannulation. Aortic Arch, Interruption, Congenitally corrected transposition of great arteries, Cannulation.

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A surgical technique for ascending aorta, aortic arch and descending aorta replacement without cross-clamp, circulatory arrest or hypothermia

Cited by 4 publications

References 7 publications

Current Strategies for the Management of Anomalous Origin of Coronary Arteries from the Pulmonary Artery

Current Strategies for the Management of Anomalous Origin of Coronary Arteries from the Pulmonary Artery

Off-pump ascending aorta or aortic arch to descending aorta bypass with a pericardial roll for the treatment of critically ill infants with interrupted aortic arch

Aortik Kros Klemp ile Myokard İskemisi Yaratmadan Konjenital Düzeltilmiş Büyük Arter Transpozisyonlu Asendan Aortu Hipoplazik Tip A Kesintili Aortik Arkı Olan Hastanın Tedavisi

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