[Total Arch Replacement with Brain Isolation Technique for Arch Aneurysm with Shaggy Aorta].

A shaggy aorta with a mobile atheromatous plaque in a thoracic lesion is considered a risk factor for cerebral infarction during aortic arch surgery. The brain isolation technique was introduced to prevent embolic stroke either by manipulating the severely atheromatous aorta, or by producing a sandblasting effect using the arterial jet in cardiopulmonary bypass. We performed total arch replacement with the aid of a brain isolation technique in four patients with aortic arch aneurysm complicated with a shaggy aorta between 2016 and 2020. Antegrade selective cerebral perfusion was established prior to systemic perfusion of the cardiopulmonary bypass. Total arch replacement using the frozen elephant technique was performed in all patients. There was no operative mortality, and all patients were discharged without major neurological complications. Therefore, the brain isolation technique could be a useful adjunctive method to prevent embolic stroke in patients who undergo total arch replacement for aortic arch aneurysm with a shaggy aorta.

[Introduction of Minimally Invasive Port-access Surgery for Aortic Valve Replacement;Yamagata University Hospital's Experience].

BACKGROUND: Minimally invasive cardiac surgery (MICS) through a small intercostal thoracotomy has many advantages, but it is still challenging because of limited mobility through the small skin incision and surgical field. The benefits of MICS should be reached without compromising the quality of the operation and increasing the morbidity and mortality of standard sternotomy approach. We have recently introduced MICS-aortic valve replacement (AVR) in order to establish as a standard surgical technique for the treatment of aortic insufficiency. METHODS: Eleven consecutive patients underwent MICS-AVR in Yamagata University Hospital. Anesthetic and surgical techniques were simplified and standardized as possible to overcome technical difficulties. Preoperative chest computed tomography( CT) provides useful information about suitability of the patient's anatomy for MICS approach. Furthermore, we developed a preoperative image overlay technique by projecting 3-dimensional CT image over the patient's body surface. RESULTS: There was no operative death. MICS-AVR procedure was completed in 10 patients. One patient was converted to sternotomy approach probably because of the vascular spasm through femoral artery cannulation for extracorporeal circulation. Although there were some anxious points to manage MICS procedure, preoperative planning based on the image overlay from CT image were useful for setup and instrument placement for MICS. CONCLUSIONS: MICS-AVR was introduced and safely performed with acceptable morbidity and excellent mortality at our institution. Close observation should be mandatory in order to implement individual and departmental performance monitoring with regard to the learning curves and surgical complications associated with less invasive procedure itself.