Separate Brain and Body Perfusion Shortens Operating Time in a Jehovah’s Witness with Arch Dissection

P0296 

Case Video Submission 

Salim Aziz (1), Vincent Gaudiani (2), Pei Tsau (3), Paul Shuttleworth (4), Jenna Aziz (5)

(1) N/A, United States, (2) El Camino Hospital, Mountain View, CA, (3) El Camino Health, Mountain View, CA, (4) N/A, San Francisco, (5) Ohio State Wexner Medical Center, Columbus, OH

Salim Aziz    -  Contact Me
N/A

Vincent Gaudiani    -  Contact Me
El Camino Hospital

Pei Tsau    -  Contact Me
El Camino Health

Paul Shuttleworth    -  Contact Me
N/A

Jenna Aziz    -  Contact Me
Ohio State Wexner Medical Center

Salim Aziz    -  Contact Me
N/A

Separate Brain and Body Perfusion Shortens Operating Time in a Jehovah's Witness with Arch Dissection


Objective: Can separation of cerebral and systemic perfusion using separate circuits to cool the brain and body at different temperatures allow for successful surgery in a Jehovah's Witness with acute Type A aortic dissection?

Case Video Summary:
We performed aortic arch reconstruction in a 79-year-old Jehovah's Witness who presented with Type A dissection in an arch aneurysm and cardiac surgery not offered at an outside hospital. We initiated assiduous control of blood pressure and measures to enhance hematopoiesis (Epogen, iron infusion, multivitamins) and standard measures to reduce blood loss (pre and intraoperative) resulting in a hematocrit on day of operation of 40.

We completely separated cerebral and corporeal perfusion. The brain was cooled to 240C and body to 340C. We maintained cerebral perfusion prior to bypass and until after cessation of cardiopulmonary bypass. Systemic circulatory arrest was initiated at 340C for 20 minutes for the distal arch anastomosis.



Surgical strategy:
1. Median sternotomy. 2.Heparinize. 3. Cannulate innominate artery with 14 F cannula. 4 Cannulate mid-arch. 5. Clamp base of innominate artery and initiate cerebral circulation
1 L/min and cool to 240C. 6. 1 minute later initiate corporeal circulation (3L/min) and cool to 340C (separate heat/exchanger). 7. Start operation immediately as described in accompanying video.

Conclusions
1. Separate perfusion and cooling temperature strategy for the body and brain shortens operation time and therefore reduce coagulopathy and blood loss. This approach should be used when operating on a Jehovah's' Witness.
2. There were no intra- or post-op complications.


 

Aortic Arch