Abstract
In previous chapters, Doctors Pettersson and Sundt described reoperation techniques in patients exhibiting complex pathologies, such as root and ascending involvement. In this chapter, various approaches will be discussed for repairing the aortic arch (Ann Thorac Surg 78: 1274–84, 2004; Ann Thorac Surg 74: 2040–6, 2002; Ann Thorac Surg 78: 2099–105, 2004; Ann Thorac Surg 78: 109–16, 2004; Ann Thorac Surg 71: 1905–12, 2001). Based on our experience, when possible, we use axillary/subclavian cannulation with a side graft for patients undergoing reoperation on the aortic arch (Ann Thorac Surg 78: 1274–84, 2004). This includes femoral vein cannulation with the cannula being fed upward into the right atrium while using transesophageal echocardiography for positioning. We recommend this because of the lower risk of stroke with deep hypothermia and circulatory arrest, and this procedure also offers the ability to both perfuse the innominate artery and run antegrade brain perfusion. Next, the patient is placed on-pump, and cooling is begun immediately as the chest is being opened. As discussed in a previous chapter, if the patient has severe aortic valve regurgitation, further plans have to be instigated to deal with this problem.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Svensson LG, Blackstone EH, Rajeswaran J, Sabik 3rd JF, Lytle BW, Gonzalez-Stawinski G, et al. Does the arterial cannulation site for circulatory arrest influence stroke risk? Ann Thorac Surg. 2004;78:1274–84.
Svensson LG, Nadolny EM, Kimmel WA. Multimodal protocol influence on stroke and neurocognitive deficit prevention after ascending/arch aortic operations. Ann Thorac Surg. 2002;74:2040–6.
Hirose H, Svensson LG, Lytle BW, Blackstone EH, Rajeswaran J, Cosgrove DM. Aortic dissection after previous cardiovascular surgery. Ann Thorac Surg. 2004;78:2099–105.
Svensson LG, Kim KH, Blackstone EH, Alster JM, McCarthy PM, Greenberg RK, et al. Elephant trunk procedure: newer indications and uses. Ann Thorac Surg. 2004;78:109–16.
Svensson LG, Nadolny EM, Penney DL, Jacobson J, Kimmel WA, Entrup MH, et al. Prospective randomized neurocognitive and S-100 study of hypothermic circulatory arrest, retrograde brain perfusion, and antegrade brain perfusion for aortic arch operations. Ann Thorac Surg. 2001;71:1905–12.
Svensson LG et al. Deep hypothermia with circulatory arrest. Determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg. 1993;106(1):19–31.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Svensson, L.G. (2012). Reoperation on the Aortic Arch. In: Machiraju, V., Schaff, H., Svensson, L. (eds) Redo Cardiac Surgery in Adults. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1326-4_18
Download citation
DOI: https://doi.org/10.1007/978-1-4614-1326-4_18
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-1325-7
Online ISBN: 978-1-4614-1326-4
eBook Packages: MedicineMedicine (R0)