Balloon Occlusion of the Ascending Aorta without Hypothermic Circulatory Arrest in Valve Surgery for Patients with a Porcelain Aorta
AbstractSevere calcification of the ascending aorta and the aortic arch complicates cardiac surgery. The optimal approach in such patients is unknown. Four valve surgeries were performed with balloon occlusion without hypothermic circulatory arrest. All patients had femoral arterial cannulation, and all 3 patients who required an aortotomy had right axillary artery cannulation as well. A balloon catheter was inserted just proximal to the brachiocephalic artery via a purse-string stitch. Good cardiac arrest was obtained in all cases, and a good bloodless field was obtained in all 3 aortic valve cases. There were no balloon-related complications. The patients all showed good postoperative courses. Balloon occlusion of the ascending aorta without circulatory arrest is effective for performing a rapid and less invasive surgery that is not significantly different from the usual valve surgery.
Blauth CI, Cosgrove DM, Webb BW, et al. 1992. Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery. J Thorac Cardiovasc Surg 103:1104-11; discussion 1111-2.nCoselli JS, Crawford ES. 1986. Aortic valve replacement in the patient with extensive calcification of the ascending aorta (the porcelain aorta). J Thorac Cardiovasc Surg 91:184-7.nCosgrove DM. 1983. Management of the calcified aorta: an alternative method of occlusion. Ann Thorac Surg 36:718-9.nGillinov AM, Lytle BW, Hoang V, et al. 2000. The atherosclerotic aorta at aortic valve replacement: surgical strategies and results. J Thorac Cardiovasc Surg 120:957-63.nGirardi LN, Krieger KH, Mack CA, Isom OW. 2005. No-clamp technique for valve repair or replacement in patients with a porcelain aorta. Ann Thorac Surg 80:1688-92.nKatircioglu SF, Cicekcioglu F, Tutun U, et al. 2008. On-pump beating heart mitral valve surgery without cross-clamping the aorta. J Card Surg 23:307-11.nKouchoukos NT, Wareing TH, Daily BB, Murphy SF. 1994. Management of the severely atherosclerotic aorta during cardiac operations. J Card Surg 9:490-4.nSvensson LG, Sun J, Cruz HA, Shahian DM. 1996. Endarterectomy for calcified porcelain aorta associated with aortic valve stenosis. Ann Thorac Surg 61:149-52.nYamashita K, Kazui T, Terada H, Washiyama N, Suzuki K, Bashar AH. 2001. Cerebral oxygenation monitoring for total arch replacement using selective cerebral perfusion. Ann Thorac Surg 72:503-8.n