Selection of Operative Adjunct for Distal Arch Aneurysm / 日本心臓血管外科学会雑誌

ABSTRACT

We have operated upon 17 cases of distal arch aneurysm, including 3 cases of rupture, during the past 6 years. Operative adjuncts during aortic cross clamping were left heart bypass with a centrifugal pump (LHB, 6 cases), retrograde cerebral perfusion (RCP, 5 cases) and selective cerebral perfusion (SCP, 6 cases). LHB was applied to localized, the aneurysm apart from the left subclavian artery. It was safely performed during operation, but cerebral embolism happened in 2 cases with aortic cross clamping. RCP was performed in emergency cases of rupture or impending rupture. Recently 3 cases were operated by left thoracotomy under RCP. One case, an 85-year-old female, was perfused for 100min by RCP, became unconsciousness and died by multiple organ failure. Although this method was simple and easy to prepare, the efficacy of cerebral perfusion is unclear and a perfusion time of less than 90min is thought to be safe. SCP was performed in 6 cases of large aneurysm, including four cases of total arch replacement. There was one operative death, but minimum complications in the survivors. Distal arch aneurysm varies in shape, location and size. Operative adjunct must be selected based on the condition of the aneurysm.