Clinical efficacy of intermittent pressure augmented-retrograde cerebral perfusion

Branched xenopericardial roll graft replacement of an infected aortic arch graft

Which graft material is the optimal graft material for the treatment of aortic graft infections is still a matter of controversy. We used a branched xenopericardial roll graft to replace an infected aortic arch graft as a “rescue” operation. The patient is alive and well 37 months postoperatively without recurrence of the infection and any surgical complication. This procedure may have the possibility to serve as an option for the treatment of aortic arch graft infection.

Xenopericardial roll graft replacement for infectious pseudoaneurysms and graft infections of the aorta

Background

Which graft material is the optimal graft material for the treatment of infected aortic aneurysms and aortic graft infections is still a matter of controversy. Orthotopic aortic reconstruction with intraoperatively prepared xenopericardial roll grafts without omentopexy was performed as the “initial” operation to treat aortic infection or as a “rescue” operation to treat graft infection. Mid-term outcomes were evaluated.

Methods

Between 2009 and 2013, orthotopic xenopericardial roll graft replacement was performed to treat eight patients (male/female: 6/2; mean age: 69.5 [55–80] yr). Graft material: equine/bovine pericardium: 2/6; type of operation: initial 4/rescue 4; omentopexy 0. Additional operation: esophagectomy 2. Mean follow-up period: 2.6 ± 1.6 (1.1–5.1) years.

Results

Replacement: ascending 3, arch 1 (reconstruction of neck vessels with small xenopericardial roll grafts), descending 3, and thoracoabdominal 1. Pathogens: MRSA 2, MSSA 1, Candida 1, E. coli 1, oral bacillus 1, and culture negative 2. Postoperative local recurrence of infection: 0. Graft-related complications: stenosis 0, calcification 0, non-infectious pseudoaneurysm of anastomosis 2 (surgical repair: 1/TEVAR 1). In-hospital mortality: 2 (MOF: initial 1/rescue 1); Survival rate exclusive of in-hospital deaths (~3 y): 100 %, but one patient died of lung cancer (3.6 yr).

Conclusions

Because xenopericardial roll grafts are not composed of synthetic material, the replacement procedure is simpler and less invasive than the standard procedure. Based on the favorable results obtained, this procedure may have the possibility to serve as an option for the treatment of aortic infections and aortic graft infections not only as a “rescue” treatment but as an “initial” treatment as well.

Electronic supplementary material

The online version of this article (doi:10.1186/s13019-015-0343-5) contains supplementary material, which is available to authorized users.

Airway obstruction by a retropharyngeal hematoma secondary to thoracic aortic aneurysm rupture

Background

Retropharyngeal hematoma is a rare form of pharyngeal pathology and can present as acute airway obstruction. Among the many causes of retropharyngeal hematoma, thoracic aortic rupture is extremely rare.

Methods and results

A 78-year-old female with airway obstruction by a retropharyngeal hematoma secondary to thoracic aortic aneurysm rupture was successfully treated by total aortic arch replacement and open stent-graft insertion.

Conclusion

Rupture of the thoracic aorta should be considered as a rare but important cause of retropharyngeal hematoma and airway obstruction.

Total aortic arch replacement with patent left internal thoracic artery graft after previous coronary artery bypass graft surgery

A 78-year-old man, who had previously undergone coronary artery bypass graft surgery, was admitted to our department for treatment of a distal aortic arch aneurysm. A total aortic arch replacement with a patent left internal thoracic artery (LITA) graft was successfully performed without cardiac ischemic or neurological complications. Use of retrograde cardioplegia with intermittent pressure-augmented retrograde cerebral perfusion without clamping and dissecting the LITA graft were effective in myocardial and cerebral protection.