Special cerebral perfusion in surgery for the ruptured thoracic aortic aneurysm

Background: For surgical treatment of the ruptured thoracic aortic aneurysm (TAA), it is important to control breeding and to protect the brain, spina l cord, and myocardium. We have developed and performed a new procedure on 6 patients with a ruptured TAA, a true aneurysm in 3 patients and a type A dissection in the other 3. Methods: Cardiopulmonary bypass is installed wit h cannulations to the iliac artery and vein and to the common carotid arter ies on both sides of the neck before the sternum is divided. For control of bleeding, venous drainage is accelerated, whereas cerebral perfusion is ma intained via the carotid arteries. After insertion of the occlusion cathete rs into the descending aorta and the left subclavian artery following the a ortotomy, the bypass flow to the iliac artery is increased. Results: The ar ch replacement was performed in 4 patients and hemiarch replacement in two. Five patients are alive without neurologic deficits; one patient died of m ulti-organ failure on the 24th postoperative day. Conclusions: We conclude that our procedure may be advantageous for patients with a ruptured TAA, a large retrosternal aneurysm, or reoperation of the thoracic aorta.