Successful resuscitation after sudden cardiac arrest in a patient with ruptured ascending aorta during thoracic endovascular aortic repair: a case report

Abstract

　We report a case of a patient with successful resuscitation following ascending aortic rupture and subsequent cardiac arrest during thoracic endovascular aortic repair (TEVAR). An 86-year-old male with thoracic aortic aneurysm developed sudden cardiac arrest following a series of stent graft balloon expansion during TEVAR. Resuscitative transesophageal echocardiogram revealed a large circumferential pericardial effusion with findings consistent with cardiac tamponade. Ruptured ascending aorta was soon identified after emergent median sternotomy and pericardiotomy. Active bleeding from the lesser curvature of the ascending aorta was eventually controlled by manual application of pressure, and it took longer than 25 minutes until spontaneous circulation returned. Ascending aorta replacement was performed under cardiopulmonary bypass with hypothermia and the patient was transferred to an intensive care unit for 48 hours of therapeutic hypothermia. Contrary to our dismal expectation on poor neurological outcome due to prolonged cardiac arrest, the patient regained fully conscious and discharged without any noticeable neurological deficit. We speculate that an induction of hypothermia under cardiopulmonary bypass immediately following ischemic insult could effectively alleviate ischemic brain damages.