Reoperation on the Aortic Arch
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.
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