Redo Total Arch Replacement in Two Cases / 日本心臓血管外科学会雑誌

ABSTRACT

We performed redo total arch replacement for recurring aortic arch diseases in 2 patients. Case 1: A 76-year-old man with 3 prior surgical interventions for aortic arch diseases was referred to our hospital for the treatment of a ruptured aortic arch pseudoaneurysm. On admission, he frequently coughed up bloody sputum. Emergency total arch replacement was performed in this patient. Case 2: A 77-year-old man who had undergone total arch replacement 9 years previously recently experienced hoarseness. A CT-scan revealed distal aortic arch aneurysm, for which we decided to perform a redo total arch replacement. Surgical strategy was similar for both patients. Cardiopulmonary bypass was established and cooling was started before resternotomy. Redo total arch replacement assisted by antegrade selective cerebral perfusion was performed using 4-branched arch grafts. Although both patients were weaned from mechanical ventilator support, the first patient died of aspiration pneumonia on the 150th postoperative day, while the second one is currently undergoing rehabilitation at our hospital. Hospital mortality is high among patients undergoing redo thoracic aortic replacement requiring resternotomy. In these patients, it is important to pursue an appropriate operative procedure and to minimize pulmonary complications.