Background: We propose a safer strategy for surgical treatment of retro-sternal pseudoaneurysms of the aortic root with severe aortic regurgitation. The objective was to allow safer re-entry in a quite and bloodless field eliminating the risk of ventricular distension and avoiding deep hypothermia.
Methods: In 6 patients presenting with postsurgical aortic root pseudoaneurysms in close proximity to the sternum associated with aortic regurgitation, we used the following techniques: femorofemoral cardiopulmonary bypass; transfemoral aortic endoclamping; percutaneous retrograde cardioplegia administration before sternotomy in patients with normal descending aorta; femoroaxillary cardiopulmonary bypass; transaxillary aortic endoclamping; percutaneous retrograde cardioplegia administration before sternotomy in patients with concomitant disease of the descending aorta.
Results: All patients survived the operation and were discharged home. Arterial cannulation and endoclamp insertion were uneventful. Reentry was uncomplicated. Deep hypothermia was avoided in all cases. No occurrences of even minor neurologic problems were observed. None of these patients experienced a postoperative low cardiac output syndrome. Postoperative course was complicated in 1 patient with re-entry for bleeding; acute renal insufficiency requiring hemofiltration in 2 patients; pneumonia in 1 patient; and soft tissues sternotomy infection in 1 patient.
Conclusions: In patients presenting with a pseudoaneurysm of the aortic root attached to the sternum and concomitant aortic regurgitation it is possible, by closed chest endovascular aortic clamping, to eliminate risks of ventricular distension and to avoid deep hypothermia.