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Patching an Aortic Tear Using the Side-Arm and Surrounding Skirt of a Physician-Modified Ascending Aortic Graft
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  • William Mitchell,
  • Hunter Mehaffey,
  • John Kern,
  • Kenan Yount
William Mitchell
University of Virginia Department of Surgery

Corresponding Author:wmmitch12@gmail.com

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Hunter Mehaffey
University of Virginia Department of Surgery
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John Kern
University of Virginia Department of Surgery
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Kenan Yount
University of Virginia Department of Surgery
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Abstract

Background: Aortic complications, such as aortic tears and dissections, during cannulation must be managed urgently and often require hypothermic circulatory arrest. We report a unique management strategy to repair an aortic tear without dissection by modifying a Dacron ascending aortic graft with side-arm to serve both as a patch for the aortic tear and inflow for the bypass circuit. Case Presentation: A 32-year-old female patient undergoing reoperative cardiac surgery suffered an unexpected aortic tear during cannulation for cardiopulmonary bypass. After promptly transitioning to femoral cannulation and hypothermic circulatory arrest, the tear was repaired by utilizing a physician-modified ascending aortic graft with side-arm, in which the surrounding skirt of the side-arm was cut from the circumferential graft to patch the defect. The patient was rewarmed with the side-arm serving as arterial inflow for the bypass circuit, and the remainder of the operation proceeded without complication. Conclusion: This type of aortic repair for aortic tears without dissection can offer the patient the benefit of avoiding multiple aortotomies in a weakened aorta, reducing circulatory arrest time, and re-establishing a central cannulation strategy for cardiopulmonary bypass, consequently reducing the likelihood of distal limb ischemia.
26 Apr 2022Submitted to Journal of Cardiac Surgery
26 Apr 2022Submission Checks Completed
26 Apr 2022Assigned to Editor
26 Apr 2022Reviewer(s) Assigned
15 May 2022Review(s) Completed, Editorial Evaluation Pending
15 May 2022Editorial Decision: Revise Major
26 May 20221st Revision Received
26 May 2022Submission Checks Completed
26 May 2022Assigned to Editor
28 May 2022Reviewer(s) Assigned
28 May 2022Review(s) Completed, Editorial Evaluation Pending
29 May 2022Editorial Decision: Accept
Sep 2022Published in Journal of Cardiac Surgery volume 37 issue 9 on pages 2920-2922. 10.1111/jocs.16660