Perfusion strategy for acute type-A aortic dissection while performing hybrid procedure like concomitant bentall operation with aortic arch replacement with modified frozen elephant trunk procedure Mr Mandal Inal, Dr Kalita Jyoti Prasad, Prof Saikia Manuj Kumar, Dr Handique Akash, Dr Alam Intekhab Department of CTVS, NEIGRIHMS, Shillong Online published on 17 October, 2018. Abstract Background The concomitant Bentall operation [1] and aortic arch replacement combined with frozen elephant trunk (FET) procedure for Stanford Type-A [2] aortic dissection remains a surgical challenge because of its complexity in operative techniques, cardiopulmonary bypass and cardiac anesthesia management which includes optimum cerebral perfusion, hypothermia and myocardial preservation. This hybrid procedure potentially allows a single stage repair of this complex disease avoiding classical two stage operation for the same pathology and possible further complication [3]. A study on this case series aimed to evaluate the safety and effectiveness of modified surgical anesthesia and perfusion strategies for hybrid technique repair of Type-A aortic diseases [4]. Methods From November 2016 to January 2017, 3 patients (3 males, mean age 43 years) were operated upon. The collapsed endoprosthesis was deployed in the descending aorta through the opened aortic arch and later it was positioned appropriately with the help of TEE and X Ray). The four branched graft segment allowed the replacement of the aortic arch and arch branches individually. Concomitant Bentall procedures were performed in all cases. Results The hybrid procedure was successful in all cases. There were no intraoperative death. One patient developed transient neurological deficit. No patients developed paraplegia or paraparesis. The mean CPB time was 260± 20 min, aortic cross clamp time was 180 ± 10 min and lower body ischemia time was 25 ± 5 min. Unilateral SACP time (during the anastomosis of LCCA) and bilateral SACP time were 20± 5 min and 100 ± 15 minutes respectively. Conclusion This hybrid surgical procedure demonstrates the superiority over conventional two stage procedure related morbidity and mortality which involves in each stages [5]. The encouraging surgical results could enable this procedure to become the new "standard" therapy for type-A dissection involving repair of the aortic arch and descending aorta. Top Keywords Hypertension, Hybrid, Dissection. Top |