chen sacs 2014 descending cases presentation compressed
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Descending Thoracic Aneurysm Repair CasesEdward P. Chen, MDDirector Thoracic Aortic SurgeryDivision of Cardiothoracic SurgeryEmory University School of MedicineAtlanta, GeorgiaSACS Annual Meeting, Wild Dunes, July 31-August 3 , 2014
Case 137 yo man with Marfan and history of:Extensive aortic aneurysmChronic type B dissectionJan, 2009: Stage I ET Total Arch/David VJan, 2010: Stage II ET open repair of Ext I TAAA with reimplantation of T9/T10Complicated by left renal infarction dxd on 6 month f/u CT scan
Case 1June, 2014:Presented with hemoptysisPE: Benign exam, equal pulsesWork-up: Bronchoscopy-clot in left bronchus, no active bleedingCTA chest/abd
June, 2014July, 2010
June, 2014July, 2010
June, 2014July, 2010
Underwent TEVAR of TAAA graft across pseudoaneurysm (outside institution)July, 2014-Recurrent Hemoptysis
July, 2014June, 2014
July, 2014June, 2014
Surgical TechniqueRedo-open TAAA (extent II) with partial CPB, not LHBExplantation of TEVAR devicesOversew of T9 and T10 intercostalsIndividual Reimplantation of celiac, SMA, right renal Cold blood perfusion of visceral vessels during reimplantationRight femoral a-line/cordisLeft femoral cutdownLumbar Drainage/SSEP/MEP monitoringCPB time 117 minOpen Repair OutcomeExtubated POD 1No organ dysfunctionLumbar drain capped POD 3; d/cd POD 4Recovering nicely
Case 249 yo man:Acute Type B Dissection-Jan 2012Arch Debranching-Feb, 2012TEVAR-April, 2012
January, 2012: Acute Type B
January, 2012: Acute Type B
Initial Surgical InterventionOutside institutionFeb, 2012: Arch DebranchingApril, 2012: TEVAR across arch
April, 2012: s/p Arch Debranching/TEVAR
June, 2012Enlargement of thoracic aortaContinued opacification of false lumen
June, 2012April, 2012
June, 2012April, 2012
June, 2012April, 2012
July, 2012Additional intervention:Coil Embolization of left subclavian artery
Aug, 2012June, 2012
Aug, 2012June, 2012
Aug, 2012June, 2012
Aug, 2012June, 2012
December, 20131 month history of dizziness, nausea and vomitingPE:Benign chest and abdominal examEqual pulses in all four extremities
Dec, 2013Aug, 2012
Dec, 2013Aug, 2012
Dec, 2013Aug, 2012
Dec, 2013Aug, 2012
Surgical TechniqueOpen repair using reverse elephant trunk technique with left chest circ arrestThoracoabdominal incision via 4th interspace and transition to 5th anteriorlyRight femoral a-line/cordisLeft femoral cutdownLumbar Drainage/SSEP/MEP monitoringCPB 193 min; Circ Arrest 57 min (upper) and 24 (lower body)
Open Repair OutcomeSeizures: EEG and Head CT negOliguric renal failureD/C to home POD 30Neuro intactDialysisJuly, 2014Off dialysis Creatinine 2.2Fully functionalAwaiting intervention on ascending/arch
Case 377 yo male presents with acute onset of back painPMH:Acute DeBakey II aortic dissection s/p Ascending aortic/hemiarch replacement with innominate reimplantation in 2009PE:Benign chest and abdominal examPulses equal in all four extremities
CeliacSMAIliac BifurcationAcute Uncomplicated DeBakey 3B Aortic DissectionMax aortic diameter: 3.9cmFalse lumen