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Cryopreserved Arterial Allograft Reconstruction After Excision of Thoracic Malignancies  Abel Gómez-Caro, MD, Elisabeth Martinez, MD, Alberto Rodríguez,

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Presentation on theme: "Cryopreserved Arterial Allograft Reconstruction After Excision of Thoracic Malignancies  Abel Gómez-Caro, MD, Elisabeth Martinez, MD, Alberto Rodríguez,"— Presentation transcript:

1 Cryopreserved Arterial Allograft Reconstruction After Excision of Thoracic Malignancies 
Abel Gómez-Caro, MD, Elisabeth Martinez, MD, Alberto Rodríguez, MD, David Sanchez, MD, Jaume Martorell, MD, PhD, Josep Maria Gimferrer, MD, Axel Haverich, MD, PhD, Wolfgang Harringer, MD, PhD, Jose Louis Pomar, MD, PhD, Paolo Macchiarini, MD, PhD  The Annals of Thoracic Surgery  Volume 86, Issue 6, Pages (December 2008) DOI: /j.athoracsur Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 (A) Chest roentgenogram showing a tumor mass in the middle mediastinum that on (B) computed tomography was close to the descending supradiaphragmatic aorta and distal esophagus (case 14). (C) The operation was made through a right thoracophrenolaparotomy that allowed a safe clamping of the aorta both proximally and distally to the tumor-invaded segment. (D) Tumor resection included a right lower lobectomy, Ivor-Lewis esophagectomy and a revascularization of the affected aorta with two cryopreserved allografts. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 (A) Computed tomography showing an invasive thymoma (case 6) involving the innominate vein and ascending aorta, already having undergone an exploratory median sternotomy. (B) Through a redo median sternotomy, the entire tumor burden was dissected in free margins from the surrounding structures, preserving the left phrenic nerve (yellow rubber tap). (C) Resection of the vessles included the entire ascending aorta with a composite graft and aortic mechanical valve interposition. (D) Revascularization of both innominate vein (white arrow, iliac artery cryopreserved allograft) and ascending aorta (black arrow) was done under total cardiopulmonary bypass and cardiac arrest. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 (A) Computed tomography showing a subocclusion of the left pulmonary artery by a pulmonary artery sarcoma (case 12) with endoluminal growth (white arrows) (B) The trunk of the pulmonary artery was involved and needed to be replaced. (C) A cryopreserved aortic arch allograft was interposed, after closing all its supra-aortic branches, between the main, supravalvular pulmonary artery and intrapericardial, retrocaval right pulmonary artery just before the take off of its first branch. (D) Angio-computed tomography scan 12 months after surgery, showing the patency of the implanted allograft. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 (A) A pediatric cryopreserved distal aorta with its bifurcation is surgically manipulated to increase its total length. (B) The graft is first opened in its medial aspects taking off the origin of both internal femoral arteries. (C) Then, the medial aspects are sutured together with a running polypropylene 5-0 sutures. Next, the same with the residual aspects. This technique has the great advantage of being able to adapt whatever cryopreserved allograft to any intrathoracic native vessel, avoiding overstretching and kinking. (D) Intraoperative view of the completed revascularization of the left innominate vein (white arrow). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

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