Safe Reentry for False Aneurysm Operations in High-Risk Patients

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Presentation transcript:

Safe Reentry for False Aneurysm Operations in High-Risk Patients Gian Luca Martinelli, MD, Attilio Cotroneo, MD, Philippe Primo Caimmi, MD, PhD, Gabriele Musica, MD, David Barillà, MD, Edmond Stelian, MD, Angelo Romano, MD, Eugenio Novelli, PhD, Luca Renzi, CCP, Marco Diena, MD The Annals of Thoracic Surgery Volume 103, Issue 6, Pages 1907-1913 (June 2017) DOI: 10.1016/j.athoracsur.2016.09.028 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 False aneurysms. Reproduced with permission from photographic archives of Clinica San Gaudenzio-Novara. (A) The false aneurysm extended anteriorly, creating a subcutaneous pulsatile mass. (B) The false aneurysm originated directly from the left ventricle (LV), shown by the arrow; the patient was included in the low-risk reentry group B. A femoral-femoral approach with a completely empty left ventricle prevented a catastrophic hemorrhage. (C) The false aneurysm originated directly from the ascending aorta, shown by the arrow. The safe reentry strategy was adopted, and the patient was included in the high-risk reentry group A. The Annals of Thoracic Surgery 2017 103, 1907-1913DOI: (10.1016/j.athoracsur.2016.09.028) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The novel perfusion system developed for high-risk patients with aortic false aneurysm, maintaining continuous cerebral and visceral perfusion. Reproduced with permission from photographic archives of Clinica San Gaudenzio-Novara. (A) Adapted perfusion system for high-risk patients with large false aneurysm. (HE = heat exchanger; OX = oxygenator; P1 and P2 = roller/centrifugal blood pump; RC = percutaneous retrograde cardioplegia catheter cannula under pressure control [approximately 30 to 40 mm Hg]; SCP = selective cerebral perfusion [at a flow rate of 10 mL · kg−1 · min−1 and 50 to 70 mm Hg carotid pressure]; SIBP = selective inferior body perfusion [at 65% of full flow (1.8 L · min−1 · m−2 at 28°C) and 70 mm Hg femoral artery pressure].) (B) Carotid cannulation technique. (C) Endoaortic balloon (arrow) inflated under transesophageal echocardiography vision to allow selective inferior body perfusion through the femoral artery to maintain femoral pressure at approximately 70 mm Hg with a flow rate of 65% of full flow. The Annals of Thoracic Surgery 2017 103, 1907-1913DOI: (10.1016/j.athoracsur.2016.09.028) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Monitor displaying pressures during the innovative perfusion system. Pressures were monitored in both carotid cannulas (selective cerebral perfusion), in left femoral artery (selective inferior body perfusion), and in the percutaneous retrograde cardioplegia catheter cannula. Reproduced with permission from photographic archives of Clinica San Gaudenzio-Novara. The Annals of Thoracic Surgery 2017 103, 1907-1913DOI: (10.1016/j.athoracsur.2016.09.028) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Kaplan-Meier survival curve of overall mortality in group A (solid line) and group B (broken line). (Log rank test, p = 0.830.) The Annals of Thoracic Surgery 2017 103, 1907-1913DOI: (10.1016/j.athoracsur.2016.09.028) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions