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The Annals of Thoracic Surgery, Vol 56, 1110-1116, Copyright © 1993 by The Society of Thoracic Surgeons
CG Massimo, LF Presenti, PP Favi, C Crisci and EA Cruz Guadron
From June 1985 to December 1991, 21 patients (12 men and 9 women; mean age,
60 years) underwent total simultaneous aortic replacement that extended
from the valve to the bifurcation. The causes of the diseased aorta were:
medial degeneration with total aortic dilatation or multiple aneurysms (n =
7) and either acute (n = 4) or chronic (n = 10) dissection. Clinical
evaluation and investigation in all patients consisted of computed
tomography and magnetic resonance imaging as well as angiography. Only
patients with combined thoracic and abdominal emergencies were selected,
and these comprised worsening of cardiac conditions resulting from aortic
regurgitation, and rapid dilatation of the ascending aorta and arch with
impending rupture in conjunction with ischemia of the abdominal viscera,
kidney, or either leg. The surgical technique consisted of inducing deep
hypothermia by means of femoral vein-femoral artery cardiopulmonary bypass.
During the cooling time, the aortic root was replaced under cardioplegia.
Once lowering of the body temperature attained electroencephalographic
silence, circulation was stopped and the aorta was replaced from the arch
to the bifurcation. Circulation and rewarming were resumed only after the
operation was completed. In our most recent patient, the operating time was
reduced by opening the thoracic and the abdominal incisions during cooling;
the cardioplegic solution as not injected but, instead, the myocardium was
cooled down along with the whole body. In these patients, the hypothermy at
electroencephalographic silence ranged from 14 degrees to 19 degrees
C.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Simultaneous total aortic replacement from valve to bifurcation: experience with 21 cases
University of Florence, Italy.
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