The Journal of Thoracic and Cardiovascular Surgery

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Presentation transcript:

The Journal of Thoracic and Cardiovascular Surgery Is it justified to apply a modified Cabrol fistula in surgical repair of acute type A aortic dissection? Hui Zhang, MD, Xijie Wu, MD, Guanhua Fang, MD, Zhihuang Qiu, MD, Liang-wan Chen, MD The Journal of Thoracic and Cardiovascular Surgery DOI: 10.1016/j.jtcvs.2018.12.082 Copyright © 2019 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A-C, Representative photographs of a 70-year-old patient with acute type A aortic dissection undergoing ascending replacement. A, The transverse pericardial sinus closure was completed by direct suture between the left atrial roof and the pericardium overlying the right pulmonary artery. During the closure, a 6-F Foley catheter was inserted into the left coronary artery and served as a guidewire for keeping the coronary artery from damage. B, Before the cardiopulmonary bypass was stopped, a bovine pericardial patch was appropriately placed to cover the pericardial recess between the superior vena cava and the pulmonary artery after no spurt bleeding was found. C, After the completion of the patch attachment, an 8- to 10-mm opening was made in the inferior inner side of the right atrium and a Foley catheter was immediately inserted into the right atrium through this opening for temporary obstruction. This catheter was withdrawn just before the suture was tied. The Journal of Thoracic and Cardiovascular Surgery DOI: (10.1016/j.jtcvs.2018.12.082) Copyright © 2019 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A-C, The extent of the bovine pericardial path coverage according to the aortic repaired extent (indicated by imaginary line). A, The top of the patch was sutured to the pericardial fold overlying the distal ascending aorta when only ascending replacement or ascending replacement combined with open placement of triple-branched stent graft was performed. B, The patch top was attached to the innominate vein when the hemiarch replacement was performed. C, During total arch replacement with a 4-branched Dacron tube graft combined with a stented elephant trunk implantation, the patch top was attached to the inferior side of the innominate vein and the upper side of the innominate vein was sutured to the upper mediastinal tissue. The Journal of Thoracic and Cardiovascular Surgery DOI: (10.1016/j.jtcvs.2018.12.082) Copyright © 2019 The American Association for Thoracic Surgery Terms and Conditions

The transverse pericardial sinus was closed, and a Foley catheter was inserted for the guidewire. The Journal of Thoracic and Cardiovascular Surgery DOI: (10.1016/j.jtcvs.2018.12.082) Copyright © 2019 The American Association for Thoracic Surgery Terms and Conditions