Operative Techniques in Thoracic and Cardiovascular Surgery最新文献

Heart-lung transplantation (HLT) frequency has decreased over the years due to the fact that most right-sided heart failure can recover without heart-lung transplantation. However, there is still a subset of the patient population suffering from end-stage cardiopulmonary disease who would benefit from combined heart-lung transplantation. The main indication for continues to be pulmonary hypertension due to idiopathic pulmonary arterial hypertension or secondary to congenital heart disease, accounting for 60%-70% of heart-lung transplants during the past 3 decades. This paper provided updated detailed illustrated technique for combined pediatric and adult heart-lung transplantation practiced at Stanford University School of Medicine and Lucile Packard Children's Hospital at Stanford. A total of, 185 of combined heart-lung transplants have performed at our institution since 1990.

The “frozen elephant trunk” (FET) technique was developed by Karck et al., who modified Borst's ET technique by using a stent graft to secure the distal ET section. Working in collaboration with Vascutek Terumo, we in Hannover Medical School introduced the 4-branched hybrid FET graft In 2012 (Thoraflex Hybrid). However, the results after open aortic arch repair mainly depend on perioperative management and patient factors. Over the years, peri-operative management and operative techniques have evolved greatly contributing to better results. We describe our surgical technique of implantation of this hybrid graft in acute aortic dissection Stanford type A, DeBakey type I (AADA DeBakey I) patients.

Objective: Reporting our experience of total arch replacement through the left thoracotomy. Patients: From October 1999 to April 2021, 69 patients, aging 62.4 ± 13.7 years (26-84), underwent extensive aortic arch replacement from the ascending aorta, aortic arch, and to the descending aorta. The aneurysm consisted with 2 acute type A dissection, 35 chronic type A dissection, 1 acute type B dissection, 11 chronic type B dissection, 12 non-dissection plus chronic type B dissection, 11 nondissection with mega-aorta, and 4 Kommerell diverticulum. Various segments of aorta were replaced prior to extensive surgery, such as aortic root 7, ascending aorta 25, arch 3, descending aorta 1, thoracoabdominal aorta 1, and AAA 3. Two had ruptured aneurysm, 2 had intraoperative aortic dissection, 3 had graft infection, 2 had tracheotomy, and 1 had cardiac arrest. Methods: Forty-five patients had left posterolateral thoracotomy, 8 had anterolateral left thoracotomy plus partial midsternotomy, 2 had midsternotomy plus left thoracotomy, 2 had right posterolateral thoracotomy, I had Clamshell bilateral thoracotomy, and 13 had left thoracotomy + retroperitoneal approach. All patients underwent total arch and descending aorta replacement. In addition, three had aortic root replacement, 3 had ST junction plication, on had AVR, 12 had reconstruction of the segmental arteries, 13 had replacement of the thoracoabdominal aorta, and 2 had esophagus resection. Sixty-five had antegrade cerebral perfusion and 4 had deep hypothermic circulatory arrest with retrograde cerebral perfusion. Results: There were 4 early deaths (5.8 %). The causes of deaths were preoperative cardiac arrest due to aneurysm rupture, low cardiac output, acute myocardial infarction, and head injury. Conclusion: Extended replacement of the aortic arch and the descending aorta might be useful for the selected patients.