Open AccessTransverse Aortic Arch Aneurysm
Author(s) -
E. Stanley Crawford,
S A Saleh
Publication year - 1981
Publication title -
annals of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.153
H-Index - 309
eISSN - 1528-1140
pISSN - 0003-4932
DOI - 10.1097/00000658-198108000-00012
Subject(s) - medicine , aortic arch , cardiopulmonary bypass , brachiocephalic artery , aneurysm , surgery , cardiology , cerebral perfusion pressure , aorta , artery , thoracic aorta , complication , perfusion , radiology
The results of graft replacement for aneurysms involving the entire transverse aortic arch have lagged far behind that achieved for similar lesions located elsewhere. For example, prior to the study reported here, the mortality rate of the former, in our experience, was 25%, whereas it was only 8% for the most extensive forms of thoracoabdominal aortic aneurysms. The difference had been due to limitations and complications of methods employed for cerebral and myocardial protection. The high mortality rate in our patients was due to the deficiencies of temporary bypass graft and cardiopulmonary bypass, and separate brachiocephalic perfusion employed for this purpose. This report is concerned with the use of profound hypothermia for cerebral protection and the application of graft inclusion and direct brachiocephalic arterial reattachment to prevent bleeding in region of operation, as so successfully employed in patients with thoracoabdominal aortic aneurysms. The entire thoracic aorta was involved in four patients, the aortic valve in two patients, coronary artery bypass was performed in two patients, and the pulmonary artery was obstructed in one patient. Employing the techniques described in this report, all eight patients with these extensive lesions survived without complication.