Abstract
Background: Aortic complications, such as aortic tears and
dissections, during cannulation must be managed urgently and often
require hypothermic circulatory arrest. We report a unique management
strategy to repair an aortic tear without dissection by modifying a
Dacron ascending aortic graft with side-arm to serve both as a patch for
the aortic tear and inflow for the bypass circuit.
Case Presentation: A 32-year-old female patient undergoing
reoperative cardiac surgery suffered an unexpected aortic tear during
cannulation for cardiopulmonary bypass. After promptly transitioning to
femoral cannulation and hypothermic circulatory arrest, the tear was
repaired by utilizing a physician-modified ascending aortic graft with
side-arm, in which the surrounding skirt of the side-arm was cut from
the circumferential graft to patch the defect. The patient was rewarmed
with the side-arm serving as arterial inflow for the bypass circuit, and
the remainder of the operation proceeded without complication.
Conclusion: This type of aortic repair for aortic tears without
dissection can offer the patient the benefit of avoiding multiple
aortotomies in a weakened aorta, reducing circulatory arrest time, and
re-establishing a central cannulation strategy for cardiopulmonary
bypass, consequently reducing the likelihood of distal limb ischemia.
Keywords: Reoperative Cardiac Surgery; Cardiopulmonary Bypass
Complications; Aortic Repair