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ASCENDING AORTIC ANEURYSM: TECHNIQUE MARKO TURINA University Hospital Zurich, Switzerland.

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Presentation on theme: "ASCENDING AORTIC ANEURYSM: TECHNIQUE MARKO TURINA University Hospital Zurich, Switzerland."— Presentation transcript:

1 ASCENDING AORTIC ANEURYSM: TECHNIQUE MARKO TURINA University Hospital Zurich, Switzerland

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5 Tension at Coronary Ostia with Graft Inclusion Technique From Crawford: Diseases of the Aorta

6 GRAFT INCLUSION TECHNIQUE: SUBSTANTIAL SOURCE OF COMPLICATIONS From Crawford: Diseases of the Aorta

7 Perigraft hematoma after wrap technique

8 Spurious Aneurysm at the Origin of RCA After Graft Inclusion Technique in Composite Graft

9 Spurious Aneurysm of the Aortic Root After Composite Graft: Detachment of the Coronary Orifice

10 COMPOSITE GRAFT IN MARFANS DISEASE: False aneurysm at the origin of LMCA Courtesy Prof.Jenni, Echocardiography USZ 35 year old male with Marfan, 9 y. after composite graft repair for acute Type A dissection Aortic valve LA RVOT True lumen BS 25 False aneurysm Composite graft (compressed) BS 25

11 FALSE ANEURYSM AT THE ORIGIN OF LMCA AFTER COMPOSITE GRAFT Aortic valve LA RVOT True lumen BS 25 Composite graft Leakage into the false aneurysm

12 Composite Graft with Open Technique

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14 Myocardial Protection in Ascending Aortic Surgery Zurich 2003 Systemic hypothermia 28 0 C Begin with retrograde cardioplegia, cross-clamp and arrest with antegrade perfusion directly into coronaries (except in acute Type A). Continuos retrograde cold oxygenated 16 0 C throughout procedure. Warm reperfusion (hot shot)

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16 Copyright ©2007 The Society of Thoracic Surgeons Etz C. D. et al.; Ann Thorac Surg 2007;84: Schematic drawing of mechanical (n = 126 patients; 61%) and biologic (n = 80 patients; 39%) valved composite grafts used for aortic root replacement using a modified Bentall technique

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18 BUTTON TECHNIQUE FOR COMPOSITE GRAFT REPAIR

19 From Barbeau et al, Ann Thor Surg 1999

20 Axillary Artery Cannulation: Essential in Arch Procedures and Acute Type A

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24 Bavaria et al., Ann Thor Surg 2003

25 Hemiarch Bentall Procedure Subclavian/Innominate Artery Perfusion Technique Monitor left and right radial, and femoral artery pressure. Cannulation of subclavian/innominate artery. Cool patient to 28 0 C. Cross clamp innominate and left carotid, block left subclavian artery with balloon, perfuse upper body with 10 ml/kg, and administer antegrade and retrograde CPL. Perform distal anastomosis first, clamp the graft and resume body perfusion. Perfrom proximal part of the operation (valve and coronaries). Re-anastomose proximal and distal graft segment.

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27 CABROLS TECHNIQUE FOR DECOMPRESSION OF PERIGRAFT SPACE J Thorac Cardiovasc Surg 81: , 1981

28 CABROLS ORIGINAL DESCRIPTION OF CORONARY ANASTOMOSIS J Thorac Cardiovasc Surg 81: , 1981

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31 Modifications of Button Technique Hilgenberg et al, Ann Thor Surg 1996 Pratali et al, Tex Heart Inst J 2000

32 Copyright ©2011 The Society of Thoracic Surgeons Malekan R. et al.; Ann Thorac Surg 2011;92: Completion Bentall procedure

33 Two common errors in ascending aortic surgery: Timid resection of aneurysm (instead of going into arch) Use too long graft (they all lengthen and distend with time, some up to 20 – 30 % of diameter)

34 Ha H I et al. Radiographics 2007;27: ©2007 by Radiological Society of North America Keep you graft short, it expands and lengthens with time!

35 Potential Source of Recurrencies: Distal Anastomosis in Ascending Aorta (Instead in Arch)


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