Clinical Results of Ascending Aorta-Abdominal Aorta Bypass / 日本心臓血管外科学会雑誌

Ascending aorta-infrarenal abdominal aorta bypass was performed in 8 patients: 4 patients with dissecting aortic aneurysm, 3 patients with thoracic aneurysm and 1 patient with stenosis of the thoracic aorta after grafting for congenital thoracic aneurysm. Four patients who had aortic dissection underwent the thromboexclusion method, but thromboexclusion of the thoracic aorta occured in only one patient after additional clamp to the distal thoracic aorta. He is the only long-term survival in this series. The thromboexclusion method was also performed in two patients with infectious thoracic aortic aneurysm, but they died of aneurysmal rupture within 13 months after operation. One patient who undewent resection of a thoracic aneurysm with extra-anatomic bypass, developed respiratory insufficiency and paraplegia, and died of pneumonia. The patient with thoracic aortic stenosis is alive and well 11 years after operation. The indications of the thromboexclusion method for thoracic aneurysm should be limited only to very poor-risk patients who seem to be inaccessible to a direct approach. Ascending aorta-abdominal aorta bypass is recommended in cases of thoracic aortic stenosis.

Clinical Experience of Right Heart Bypass Using Heparin-coated Tube and Roller Pump System / 日本心臓血管外科学会雑誌

A 47 year-old man with frequent attacks of ventricular tachycardia (VT) due to arrhythmogenic right ventricular dysplasia (ARVD) developed severe right heart failure following cryoablation of the multiple VT focuses. Inotropic support and intraaortic balloon pumping failed to maintain the systemic circulation, so that we performed the right heart bypass (RHB) using a heparin-coated tube and roller pump. With the use of RHB, systemic circulation improved. We attempted to wean the patient off after 14 days RHB support. However this was unsuccessful because of poor RV function, and RHB was recommenced. The patient finally died of multiple organ failure on the 21st postoperative day, but the major organ function was well maintained for at least two weeks. The heparin-coated tube and roller pump system is easy to handle, and is suitable as a short term lifesaving adjunct for severe right ventricular failure.