Patching an Aortic Tear Using the Side-Arm and Surrounding Skirt of a
Physician-Modified Ascending Aortic Graft
Abstract
Background: Aortic complications, such as aortic tears and
dissections, during cannulation must be managed urgently and often
require hypothermic circulatory arrest. We report a unique management
strategy to repair an aortic tear without dissection by modifying a
Dacron ascending aortic graft with side-arm to serve both as a patch for
the aortic tear and inflow for the bypass circuit. Case
Presentation: A 32-year-old female patient undergoing reoperative
cardiac surgery suffered an unexpected aortic tear during cannulation
for cardiopulmonary bypass. After promptly transitioning to femoral
cannulation and hypothermic circulatory arrest, the tear was repaired by
utilizing a physician-modified ascending aortic graft with side-arm, in
which the surrounding skirt of the side-arm was cut from the
circumferential graft to patch the defect. The patient was rewarmed with
the side-arm serving as arterial inflow for the bypass circuit, and the
remainder of the operation proceeded without complication.
Conclusion: This type of aortic repair for aortic tears without
dissection can offer the patient the benefit of avoiding multiple
aortotomies in a weakened aorta, reducing circulatory arrest time, and
re-establishing a central cannulation strategy for cardiopulmonary
bypass, consequently reducing the likelihood of distal limb ischemia.