Safe Reentry for False Aneurysm Operations in High-Risk Patients

Bilateral antegrade cerebral perfusion during hypothermic circulatory arrest before sternal reentry for aortic pseudoaneurysm repair

Sternal reentry for repair of aortic pseudoaneurysms poses a unique technical challenge to prevent exsanguination. Initiation of peripheral cardiopulmonary bypass and deep hypothermic circulatory arrest prior to reentry are the cornerstones of a successful surgical approach. Adjunctive bilateral antegrade cerebral perfusion increases safe arrest time and reduces neurologic morbidity. Herein, we describe our safe reentry technique for aortic pseudoaneurysm repair in two patients.

Get out of trouble during redo surgery for false aneurysm of the ascending aorta

Postoperative thoracic aortic false aneurysm is a challenging complication of aortic surgery. We describe our surgical approach for an 8-cm thoracic aorta false aneurysm in a 59-year-old woman who had previously undergone aortic surgery. Surgery must be planned carefully because massive hemorrhage during resternotomy is a dreadful complication of postoperative false aneurysm surgery. We decided to start cardiopulmonary bypass before resternotomy and use a ventricular vent from the apex, an endo-vent from the pulmonary artery, and an endo-balloon with antegrade blood cardioplegia. We successfully performed the procedure without profound hypothermia and circulatory arrest and with a low risk of hemorrhage.