Redo Total Arch Replacement for a Patient with Pseudoaneurysm of the Thoracic Aortic Graft / 日本心臓血管外科学会雑誌

Aortic pseudoaneurysm is a rare but life-threatening complication after graft replacement. One of the main challenges of surgery is the appropriate and safe method of re-entering the chest cavity. Therefore, it is necessary to consider a strategy which includes cardiopulmonary bypass. The patient was a 64-year-old man who had undergone hemi-arch replacement for pseudoaneurysm of the native thoracic aorta 17 years previously. The exact surgical details of the previous operation were unknown. He experienced progressive chest pain for 1 month, and noticed a parasternal pulsatile mass. An enhanced computed tomographic scan revealed a pseudoaneurysm originating from the thoracic aortic artificial graft itself, which had eroded the left parasternum and which would possibly rupture out of the skin. Preoperative examinations suggested a high risk of bleeding if redo sternotomy was performed. Therefore, we decided to perform open surgical repair with a cardiopulmonary bypass with cannulation through the femoral artery and vein before resternotomy. In addition, we performed a transthoracic left ventricular venting and selective cerebral perfusion using bilateral axillary arteries, which enabled core cooling in case of uncontrollable hemorrhage. He successfully underwent redo graft replacement of the thoracic aorta, and his postoperative course was uneventful.

Risk Factors for Prolonged Pleural Effusion after Total Cavopulmonary Connection by Multivariate Analysis / 日本心臓血管外科学会雑誌

We evaluated risk factors for prolonged pleural effusion after surgery in 35 children who underwent total cavopulmonary connection (TCPC). Duration of their chest tube drainage was 5.4±7.0 days (1-41, median 3). In univariate analysis, significant risk factors for prolonged pleural drainage over 7 days were preoperative body weight (<i>p</i>=0.03), preoperative cardiothoracic ratio (<i>p</i>=0.03), cardiopulmonary bypass (CPB) time (<i>p</i>=0.02), homologous blood transfusion (<i>p</i>=0.03), serum protein concentration at CPB weaning (<i>p</i>=0.04), central venous pressure (CVP) averaged during 3 postoperative days (<i>p</i>=0.01) and body weight change during 3 postoperative days (<i>p</i>=0.01). However multivariate analysis showed only CVP averaged during 3 postoperative days was a significant risk factor for prolonged chest tube drainage (<i>p</i>=0.03, odd's ratio 3.3). In conclusion, to keep the central venous pressure as low as possible during the early postoperative period might decrease the duration of pleural drainage.