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Thoracic Surgery

Thoracic Surgery. Brian Schwartz, CCP Perfusion Technology II. Dissections. Aortic Dissection: Occurs when blood penetrates the aortic intima and forms an expanding hematoma within the vessel wall, usually separating the intima and media. Classification of Aortic Dissections.

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Thoracic Surgery

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  1. Thoracic Surgery Brian Schwartz, CCP Perfusion Technology II

  2. Dissections • Aortic Dissection: • Occurs when blood penetrates the aortic intima and forms an expanding hematoma within the vessel wall, usually separating the intima and media

  3. Classification of Aortic Dissections • DeBakey Classification • Depends on the location of the intimal tear and the section of the aorta involved • Type I: The intimal tear is located in the ascending aorta and involves the ascending and descending aorta as well as the arch • Type II: The tear is in the ascending aorta, involving only the ascending aorta stopping before the innominate artery • Type III: The intimal tear is located in the descending aorta and the dissection involves the descending portion of the aorta

  4. Classifications

  5. New Classification for Aortic Dissections • Stanford Classification • Type A: Dissections that involve the ascending aorta regardless of where the intimal tear is located and regardless how far the dissection propagates • Type B: Dissections that involve the aorta distal to the origin of the left subclavian artery

  6. Stanford Dissections Type A Type A Type A Type B

  7. Various Types of Aortic Dissectons

  8. Risk Factors for Aortic Dissections • History of hypertension • Advanced age (patients over the age of 60) • Sex…Males are 5 times more likely than women • Marfan’s Syndrome • Congenital Heart Disease (Coarctation of aorta, biscupid aortic valve)

  9. The difference between aortic aneurysm and dissection • An aortic aneurysm involves the dilation of all three layers of the blood vessel

  10. Aortic Aneurysm

  11. Repair of Ascending Aortic Dissection/Aneurysm • Normal cannulation sites if surgeon is able to clamp the aorta • If pathology involves the innominate artery, surgeon must cannulate femoral artery • Need to cool patient to 18 degrees (deep hypothermia) • Shut off pump (circulatory arrest) while surgeon repairs the aorta

  12. Aortic Root Replacement

  13. Repair of Ascending Aortic Dissection/Aneurysm • Retrograde Cerebral Perfusion • Utilized when surgeon can’t cannulate aorta • A technique used during circulatory arrest procedures to help reduce neurological problems • Deliver oxygenated blood through the SVC to perfuse brain in a backward fashion • Pressures and Flows are extremely important • Pump Flows between 500cc/min to one liter/min • CVP no more than 25mmHg • Communication with surgeons is a MUST: • Clamps • Blood Return and Blood Color • Time

  14. Safe Period During Circulatory Arrest

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