Safe sternal reentry in the setting of a giant aortic @entity2849 and XXXX .

@entity1 @entity1353 @entity149 @entity337 @entity1167 @entity2849
OBJECTIVE: We present the use of selective cerebral perfusion via bilateral carotid artery cannulation in a @entity1 requiring complex reoperative aortic surgery. Reports describing this technique are limited. METHODS: A 66-year-old @entity1 with a previously repaired type A dissection and worsening @entity1353 was found to have a giant ascending aortic @entity2849 compressing the right pulmonary artery and vein secondary to dehiscence of the ascending aortic graft from the proximal and distal anastomoses. Moderate-to-severe @entity337 was shown by transthoracic echocardiogram. RESULTS: Cold blood selective cerebral perfusion via bilateral carotid artery cannulation was achieved using 14-French pediatric arterial cannulas (750 mL-1.0 L/min). The left ventricle was effectively decompressed via placement of an apical vent through a left anterolateral thoracotomy. Electroencephalographic quiescence was observed before sternal entry. We proceeded with replacement of the aortic arch under deep hypothermic @entity1167 (34 minutes) and Cabrol root replacement. Cerebral blood flow was maintained throughout the case and the @entity1 suffered no @entity149 . CONCLUSIONS: Selective cerebral perfusion via carotid artery cannulation can safely preserve cerebral blood flow in the setting of complex reoperative surgery of the thoracic aorta.
