Giant Ascending Aorta Pseudoaneurysm Repair Under DHCA and ACP: A Surgical Case Report With Anatomical and CT/TEE Correlation

Aortic ascending pseudoaneurysm (AAP) is a rare and challenging pathology whose understanding could be demanding for cardiothoracic residents. Video reports of this condition are scarce and the correlation between the surgical findings and the preoperative diagnostic images are often not performed.

The authors present a clinical case which focuses on the correlation between anatomy and CT/TEE findings as well as perfusion and brain protection strategy. Regarding AAP etiology, previous cardiac surgery is often associated and traumatic, and infectious events could also be present. Aortic root procedures are the most commonly associated procedures, accounting for 55% of cases in a retrospective study of a series of patients published in 2010 (1). In the same way, a recent systematic review concludes that AAPs are almost always associated with a history of aortic surgery (2). Clinical presentation of postoperative AAP usually occurred within two years of the initial operation with an incidence of 0.5% according to another report (3). Surgical repair remains the standard treatment for this kind of patient, whereas endovascular therapies (mainly occlusion devices) have been reported and could be useful in high-risk patients (2). Surgical repair usually requires circulatory arrest, brain protection, and peripheral cannulation in order to achieve an optimal exposure of the AAP and prevent cardiac injury during thorax opening. The authors conducted an allograft replacement of the ascending aorta with DHCA and bilateral antegrade cerebral perfusion during this clinical case. Perfusion and brain protection strategies were focused in this video with educational purposes.

References

1. Malvindi PG, van Putte BP, Heijmen RH, Schepens MA, Morshuis WJ. Reoperations for aortic false aneurysms after cardiac surgery. Ann Thorac Surg. 2010 Nov;90(5): 1437-1443.
2. Quevedo HC, Santiago-Trinidad R, Castellanos J, Atianzar K, Anwar A, Abi Rafeh N. Systematic review of interventions to repair ascending aortic pseudoaneurysms. Ochsner J. 2014; 14: 576-585.
3. Atik FA, Navia JL, Svensson LG, Vega PR, Feng J, Brizzio ME, et al. Surgical treatment of pseudoaneurysm of the thoracic aorta. J Thorac Cardiovasc Surg. 2006 Aug;132(2):379-385.

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