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Re-do Surgery for Type A Aortic Dissection: Aortic Rupture During Sternotomy
This video demonstrates the author’s technique for re-operation on type A aortic dissection. The patient developed aortic dissection while weight-lift training in December 2013. A CT scan revealed a large intimal tear at the aortic arch. The patient’s ascending aorta was replaced with a Dacron graft. The follow-up studies showed an enlarging dissecting aneurysm. The author operated on the patient in July 2014. To prevent blood loss and brain ischemia caused by aortic rupture during sternotomy, the patient was put on pump through the femoral artery, bilateral carotid arteries, and femoral vein. During the sternotomy, the Dacron graft was cut. The systemic perfusion was stopped, and the brain was protected by carotid perfusion. The total aortic arch was replaced with a vascular ring connector, and a fresh elephant trunk was inserted with a guide-wire pulling technique. Blood loss was 550 ml. The heart ischemic time was 143 minutes and pump time was 196 minutes.