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J Thorac Cardiovasc Surg 2009;138:1029-1030
© 2009 The American Association for Thoracic Surgery

Brief Technique Report

Transcranial Doppler-guided selective antegrade cerebral perfusion during aortic debranching operation

Ali Khoynezhad, MD, FACC, FACPa, Rolando Celis, MDb,*

a Section of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, Neb
b Section of General Surgery, University of Nebraska Medical Center, Omaha, Neb

Received for publication April 10, 2008; accepted for publication May 18, 2008.

* Address for reprints: Rolando Celis, MD, University of Nebraska Medical Center, General Surgery, 982315 Nebraska Medical Center, Omaha NE 68198-2315. (Email: rcelis@unmc.edu).

The first 20% of the full text of this article appears below.


   Introduction
 
We report the utility of transcranial Doppler (TCD) during hybrid repair of an aneurysmal enlargement of a proximal descending thoracic aortic dissection. TCD provided critical information for the need of selective antegrade cerebral perfusion (SACP) and adequacy of cerebral blood flow during the procedure.


   Clinical Summary
 
A 64-year-old man with acute type A aortic dissection had emergency aortic valve repair, annuloplasty of sinutubular junction, and hemiarch replacement. He recovered well from the original operation. However, on postoperative day 4, a computed tomography scan obtained due to back pain revealed expansion of the false lumen of the aortic arch distal to the previous hemiarch graft. The patient did not wish a second operation with hypothermic circulatory arrest to replace the total arch, but agreed to undergo extra-anatomic bypass of the brachiocephalic vessels (aortic debranching) followed by endografting of the distal aortic arch and the proximal descending thoracic aorta.

In the operating room, access to the chest was gained through his previous median sternotomy. The main body (14 mm) . . . [Full Text of this Article]






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