Aortic Surgery Video from Mass General

[Arlyss]

For those whose aorta is affected along with their aortic valve, this surgery video shows one of the most complex procedures, if not the most complex.

There is a specific point made about the old theory called post-stenotic dilatation, which is extremely important for those with BAV to understand.

It is the last video at the bottom of this link

http://www.massgeneral.org/surgery/webcast/

Best wishes,
Arlyss

 

[Arlyss]

There is another video on this page also, about the use of stent grafts on aneurysms in the descending aorta. It is not clear how long these stents can be implanted without developing problems, so the implications of use in younger people still are not known. I am aware of one younger person who had to have full open surgery to remove the stent and replace the aorta with Dacron.

In older people who may not be eligible for open surgery on this part of the aorta, who are typical of many with aneurysms in this part of the aorta, these stents are an important option.

While many surgeons may offer to perform a partial removal of the ascending aorta, full resection of the ascending aorta, surgery on the arch, and on the descending aorta are not offered by very many surgeons because of the complexity and risk.

Best wishes,
Arlyss

 

[Andrew'sMom]

Is the antegrade cerebral perfusion used in this video replacing deep hypothermic circulatory arrest? or are there some instances where DHCA must still be used? Has anyone here on VR.com had surgery using antegrade cerebral perfusion? Is it correct that this method (antegrade cerebral perfusion or DHCA) is used only during re-section of the aortic arch, or is it necessary for re-section of the ascending aorta as well?

very informative & interesting video. Thank you Arlyss.

 

[Gusdog]

Has anyone here on VR.com had surgery using antegrade cerebral perfusion? Is it correct that this method (antegrade cerebral perfusion or DHCA) is used only during re-section of the aortic arch, or is it necessary for re-section of the ascending aorta as well?

My surgery used antegrade cerebral perfusion, though I don't know a lot about it. As far as I know, it is only used during re-section of the arch, but I'm not as knowledgeable yet as many of the folks here.

 

[Jkm7]

Gave me the creeps looking at the heart surgeries as I kept wondering if that was the OR I was in for either of my OHS....were those the scrub nurses etc? I'm glad it wasn't my surgeon in the video.

 

[Donnchadh]

I have been told I will require DHCA during my procedure to replace my aortic root and ascending aorta along with my BAV.
Though I will now bee asking about ante grade cerebral perfusion and its relevance.

 

[CThrock]

Wow, all that just amazes me.. I've watched open heart surgeries on health channel. Can't believe I want through all that and still ticking away....

 

[Arlyss]

Deep hypthermic circulatory arrest protects the brain without blood flow for about 30 minutes. That why it is important to find out the typical DHCA time of the surgeon who will use it to perform aortic surgery on you.

If a procedure is going to take too long, a way to have blood flow to the brain is needed. That is where antegrade cerebral perfusion comes in. (Retrograde was also tried, but I understand that was discarded - outcomes not as good.)

If the procedure can be done within the time limits of DHCA, that is what I personally would want. Flowing blood into the brain has its own set of challenges.

This surgery is extremely complex, but it represents hope and help for those with aortic arch aneurysms. Replacing the aortic arch is likely the most difficult thing to do in the chest, because of the implications to the brain.

The descending aorta is also difficult, because surgery there may interrupt blood flow to the spinal cord and cause paralysis and possible injury to kidneys.

That is why these surgeries are done by by expert hands in expert centers.

Best wishes,
Arlyss

 

[Gusdog]

I will share my anecdotal experience w/ DHCA and ACP, for what it's worth. I had both, as a portion of my arch had to be replaced. I was pretty uptight about it. My grandmother had her aorta re-sected in 2000 under DHCA (I don't think they even did retrograde cerebral perfusion then, but I'm not sure). Granted, she was 72 and may have had some other cognitive complications, but the procedure was completed within the prescribed 30-40 minutes, but she never woke up.

My dad's aneurysm was confined to the root, so as I understand it, he didn't need DHCA at all. According to the video, DHCA results in some cognitive issues (I can't remember how they put it, but it includes disorientation and forgetfulness) even when successful. I had less of that than my father did without and cerebral perfusion issues other than being "on pump." Now granted, he was 21 years older at his procedure than I was at mine, but I still expected to have more "pump head" than he did.

I guess my point is, no matter how long I would be under circulatory arrest, I want the ACP. That's easy for me to say having been through it successfully, but I was so pleasantly surprised by how well it went for me. It's a complex procedure, and I would recommend that anyone facing this put themselves in expert hands.

 

[Arlyss]

Hi Gusdog,

You and your family have gone through a great deal because of aortic disease. I am so sorry. Some day it will be better than it is today, even though where we are now is a great leap forward from the past.

Although the results of aortic surgery are really very good in expert hands today, the risk of death or injury is not zero. Straightforward valve surgery has not achieved zero risk.

There are so many variables, including the condition of the individual person. Surgeons may be somewhat like chefs - they find the best combination of ingredients in their hands, in conjunction with what their patient brings to them.

I'm glad that a combination of DHCP and ACP worked well for you. There is considerable publication in the medical literature about it from reputable centers.

Best wishes,
Arlyss

 

[Gusdog]

Although the results of aortic surgery are really very good in expert hands today, the risk of death or injury is not zero. Straightforward valve surgery has not achieved zero risk.

There are so many variables, including the condition of the individual person. Surgeons may be somewhat like chefs - they find the best combination of ingredients in their hands, in conjunction with what their patient brings to them.

Thanks, Arlyss. And you're right to point out that different circumstances require different approaches. I guess my point is to say that I really believe that I would have had a more difficult recovery without ACP, though it's not possible to say that conclusively.

While aortic disease has taken quite a toll on my family, we're still very fortunate that others have gone before and that surgical treatment has progressed so much in recent years.