ascending aorta replacement

Treatment of disease: ascending aortic aneurysm Indication Ascending aortic replacement is applicable to: 1. Ascending aortic fusiform aneurysm, giant cystic aneurysm or mixed aneurysm has a wide range of lesions. The aorta of the lesion should be removed and then grafted. 2, type II thoracic aortic dissection, lesions are limited to ascending aorta, need to do ascending aortic resection and vascular grafting. 3, there must be no aortic regurgitation, and there is no obvious expansion of the aortic sinus or sinus tube. Otherwise, aortic valve replacement or angioplasty should be performed at the same time, or with a combined valved procedure. Contraindications Severe liver, kidney, lung, brain insufficiency or intolerance to surgery. Preoperative preparation 1, preoperative special examination before the operation of aortic angiography, to determine the extent, location and pathological features of the lesion, as an important basis for the choice of surgical methods. MRI or spiral CT revascularization imaging techniques can also be used to determine the diagnosis of aneurysms. In patients with aortic regurgitation or coronary heart disease, left ventricular and coronary angiography should be performed at the same time as aortic angiography. 2, a comprehensive examination of the function of important organs including heart, lung, liver, kidney function, etc., to determine whether there is no functional damage of important organs. 3. Discover and treat chronic infections such as periodontitis, chronic otitis media, urinary and reproductive system infections, and chronic bronchitis. The above-mentioned chronic suppurative lesions should be properly treated and can be operated after being cured. 4, antibiotics for thoracic aortic aneurysm surgery due to large wounds, need to do artificial blood vessel transplantation, in order to prevent postoperative infection, it is advisable to apply antibiotics before surgery. 5. In order to prevent bleeding and bleeding during and after surgery, platelets or fresh whole blood should be prepared. Aprotinin can be used during surgery. Surgical procedure 1, chest incision A midline incision is made. Because the ascending aortic aneurysm is close to the sternum, it is better to use a swinging sternum saw when opening the sternum to avoid causing major bleeding from the wall. If necessary, first systemic heparinization, femoral artery, venous intubation, preparation for extracorporeal circulation. 2, establish extracorporeal circulation The superior and inferior vena cava cannulae are used to facilitate the drainage of the superior vena cava. The common femoral artery cannula is used as the blood supply tube, and the left heart decompression tube is disposed through the left atrium of the right superior pulmonary vein. During the extracorporeal circulation cooling, the pericardial reflex above the aortic aneurysm is separated and the beginning of the innominate artery is revealed. When the temperature of the nasopharyngeal drops to 28 ~ 30 ° C, the ascending aorta is blocked under the innominate artery with a blocking forceps, cold cardioplegia is injected into the root of the ascending aorta, the heart is arrested, and the coronary artery is opened every 20 minutes. Or through the coronary sinus continuous retrograde perfusion of cardioplegia to maintain the heart in a deep low temperature state. 3, aneurysm incision and exploration Cut the anterior wall of the aneurysm and carefully observe the changes of the intima. If there is a blood clot, it should be separated and removed. After washing, observe the normal blood vessels at both ends, the closed state of the aortic valve, and whether the coronary artery opening is violated. 4, anastomosed artificial blood vessels The artificial blood vessel with the same diameter as the aorta after pre-coagulation was firstly made with a proximal anastomosis, and a 3-0 or 4-0 polypropylene thread was used for continuous valgus suture. The first needle is from the outside of the artificial blood vessel to the inside, and then the needle is inserted from the upper left coronary artery to the right coronary artery, and the needle is sutured from the lower aorta through the aortic full layer to suture the posterior wall of the aorta. Then, the anterior wall suture is performed with the needle at the other end of the suture, the needle is inserted from the inner side of the anterior wall of the aorta, and then penetrated by the artificial blood vessel, and when the suture of the posterior wall meets, the suture is knotted. The stitch length should be within 2 to 3 mm and should be kept at the same level. If the vessel wall is weak, the application should be reinforced with a spacer. After the proximal anastomosis, the artificial blood vessel is trimmed in the same direction as the lumen of the distal aorta, that is, the anterior long and short oblique planes are sutured in the same manner as described above. Before the knotting, water is injected into the lumen of the blood vessel, and then the patient is placed in the head low position, the needle is placed in the aortic root, and the extracorporeal circulation flow is temporarily lowered, and the aortic occlusion forceps are slowly released. If there is active bleeding, apply a padded suture repair, such as anastomotic oozing, after stopping the extracorporeal circulation and the application of protamine and heparin, oozing can stop. 5, pruning aortic aneurysm wall The excess tumor wall is cut off, and the remaining part is wrapped around the artificial blood vessel for continuous suture closure, which can play a role in oppression and hemostasis.