Large Ascending Aortic Aneurysms Eroding the Sternum / 日本心臓血管外科学会雑誌

ABSTRACT

In particular, pseudoaneurysms formed at suture lines often are injured during resternotomy. Between 1993 and 1997, 5 patients with large ascending aortic aneurysms eroding the sternum underwent graft replacement using profound hypothermic circulatory arrest. A VA bypass was established through the femoral artery and vein and the patients were cooled to achieve profound hypothermia. After total disappearance of EEG activity was confirmed, circulatory arrest was established and resternotomy was conducted. In 4 patients who had pseudoaneurysms at proximal suture lines, the aneurysms were injured during resternotomy, however the grafts above the aneurysms were clamped 5 to 10min after resternotomy and cardiopulmonary bypass resumed. Infected grafts were removed and replaced with new grafts in 4 cases and hemiarch repair was conducted in 1 case. There was 1 hospital death due to multiple organ failure. Four patients survived operations and were discharged without any deficit. The hypothermic circulatory arrest technique makes it easier to obtain a good operative field and to manage any rupture immediately than by the selective cerebral perfusion technique.