Abstract
A 59 year-old man with DeBakey type I dissecting aneurysm had underwent Bentall operation and graft replacement of the aortic arch using “elephant trunk” technique, and developed cardiogenic shock following the operation. Femoro-Femoral Veno-Arterial bypass (VAB) combined with intraaortic balloon (IAB) pumping was utilized effectively. However, the left brachial arterial pressure fell down to 20mmHg suddenly, while the femoral arterial pressure elevated to 200mmHg. To clarify this phenomenon, we studied the hemodynamic effect of IABP after “elephant trunk” technique by using mock circulation. When the IAB was extruded 10cm from the graft, upper-lower blood flow ratio (Qu/Q1) was reduced to 0.18 from 1.0 on IABP, which revealed the preferential blood flow to the lower half of the body. Tn “elephant trunk” technique using a graft with small diameter, collapse of the graft was observed at IAB inflation, and the pump function toward the non-fixed terminus was observed. These findings indicated that IABP should not be used as a circulatory assist for postcardiotomy shock after “elephant trunk” technique.
