P056. Aorto-carotid Bypass at the Time of Central Repair for Type A Acute Aortic Dissection to Prevent Ischemic Stroke
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Maebashi, Gunma
Japan - Contact Me
Dr. Tomonobu Abe is a board certified cardiovascular surgeon with over 20 years of experience, specializing in adult cardiac and aortic surgery and is a professor of surgery and the division head of cardiovascular surgery in Gunma University. After graduating from Nagoya University graduate school of medicine in 1992 and completing residency and fellowship in general surgery and cardiovascular surgery in Japan, he had been trained in Toronto General Hospital as a clinical fellow from 1999 to 2001. He was appointed as the director of devision of cardiovascular surgery, department of surgery, Gunma University, Maebashi, Japan in 2018.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective
Perioperative stroke is one of the most important complications of acute type A dissection surgery. We have been performing extra-anatomical aorto-carotid bypass in selected patients with static obstruction of the carotid artery with clinical signs of neurological deficit or marked intraoperative cerebral hypoxia without signs of cerebral edema. Mainly two situations, preoperative transient ischemic attack and intra-operative drop of regional oxygen saturation of the brain fit the principle.
Case Video Summary
The presented case was a 67 year old female. She was brought to our hospital 2 hours after the onset of backpain and weakness in the left lower limb. She opened her eyes and was able to tell her name. Computed tomography images showed 90% of static obstruction of the right catotid artery. The left external iliac artery was blocked.
Since this patient was neurologically intact, we planned usual central repair with exposure of the right neck in case. Pre-sternotomy carotid artery echo showed forward blood flow in the narrow true lumen. We did usual arch replacement with selective cerebral perfusion via the callulae for three vessels, which is the routine ajunctive methods in our institution. After completing the anastomosis to the brachiocepharic artery, there was a marked drop of regional oxygen saturation (RSO2) on the right forehead. The right carotid artery was exposed and echo showed that true lumen was completely blocked. We cut the adventitia and evacuated thrombus from the false lumen. There was some forward blood flow detected by echo. However, the saturation did not improve. We then cut the true lumen and confirmed the forward flow. We replaced a short part of the carotid artery. The saturation did not improve. We finally decided to do extra-anatomical bypass. After the completion the brain saturation markedly improved in the right side as well as some improvement in the left side.
We have been doing this procedure for five cases until the end of 2021 and having good results.
Conclusion
We consider Aorto-carotid bypass at the time of Central repair of Acute type A dissection may be useful to prevent perioperative stroke in some cases.
Authors
Tomonobu Abe (1), Wataru Tatsuishi (2), Yasunobu Konishi (2), Atsushi Oi (2), Yuya Nozawa (2)
Institutions
(1) Gunma University, Japan, (2) Gunma University, Maebashi, NA
Perioperative stroke is one of the most important complications of acute type A dissection surgery. We have been performing extra-anatomical aorto-carotid bypass in selected patients with static obstruction of the carotid artery with clinical signs of neurological deficit or marked intraoperative cerebral hypoxia without signs of cerebral edema. Mainly two situations, preoperative transient ischemic attack and intra-operative drop of regional oxygen saturation of the brain fit the principle.
Case Video Summary
The presented case was a 67 year old female. She was brought to our hospital 2 hours after the onset of backpain and weakness in the left lower limb. She opened her eyes and was able to tell her name. Computed tomography images showed 90% of static obstruction of the right catotid artery. The left external iliac artery was blocked.
Since this patient was neurologically intact, we planned usual central repair with exposure of the right neck in case. Pre-sternotomy carotid artery echo showed forward blood flow in the narrow true lumen. We did usual arch replacement with selective cerebral perfusion via the callulae for three vessels, which is the routine ajunctive methods in our institution. After completing the anastomosis to the brachiocepharic artery, there was a marked drop of regional oxygen saturation (RSO2) on the right forehead. The right carotid artery was exposed and echo showed that true lumen was completely blocked. We cut the adventitia and evacuated thrombus from the false lumen. There was some forward blood flow detected by echo. However, the saturation did not improve. We then cut the true lumen and confirmed the forward flow. We replaced a short part of the carotid artery. The saturation did not improve. We finally decided to do extra-anatomical bypass. After the completion the brain saturation markedly improved in the right side as well as some improvement in the left side.
We have been doing this procedure for five cases until the end of 2021 and having good results.
Conclusion
We consider Aorto-carotid bypass at the time of Central repair of Acute type A dissection may be useful to prevent perioperative stroke in some cases.
Authors
Tomonobu Abe (1), Wataru Tatsuishi (2), Yasunobu Konishi (2), Atsushi Oi (2), Yuya Nozawa (2)
Institutions
(1) Gunma University, Japan, (2) Gunma University, Maebashi, NA
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.