Total Thoracic Aorta Replacement with Low-Flow Perfusion to Prevent Atheroembolism

Abstract

A 70-year-old man was hospitalized for the treatment of saccular aneurysm of the arch aorta and chronic dissecting aortic aneurysm with a history of type B dissection. Contrast-enhanced computed tomography showed many arteriosclerotic plaques protruding into the lumen of the arch and descending aorta. In order to prevent embolism caused by atheroma scattering, we performed total thoracic aortic replacement with selective cerebral extracorporeal circulation after cooling via an anterolateral thoracotomy with partial sternotomy at a blood flow rate of 1/2 standard flow. No postoperative organ damage was observed, and there was no brain/spinal cord complication ; he was discharged from the hospital on foot on the 13th postoperative day. This “low-flow perfusion” method for preventing atheroma destruction by a blood flow jet is an effective method for preventing embolism without disturbing the balance of oxygen demand supply while maintaining the total circulation by continuing the cardiac output during the cooling process.