Yoon Su Young, Kim Si-Wook, Kim Dohun, Hong Jong-Myeon
Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Seowon-Gu, Cheongju 28644, Republic of Korea.
Trauma Center, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Seowon-Gu, Cheongju 28644, Republic of Korea.
J Biomed Res. 2020 Oct 30;35(1):72-74. doi: 10.7555/JBR.34.20200085.
After type A acute aortic dissection (AAD) repair or modified Bentall procedure, uncontrollable bleeding from the anastomotic sites of the fragile dissected tissues or aortic root area is a critical situation to a cardiac surgeon. For postoperative care, lots of blood transfusion with strict monitoring on the patient all night and subsequent reoperation for the bleeding control is usually needed. We managed to make contained local compression of upper half of the heart, from upper part of the right ventricle to just above the innominate vein, using bovine pericardium with closing both sides of transverse sinus in two cases of uncontrolled postoperative bleeding (bleeding from distal anastomotic site in type-A AAD and valve sitting site in modified Bentall procedure). Even though reoperations for the removal of packed gauges were done in both cases 2 days later, postoperative courses at intensive care unit were very smooth with little need for transfusion. This kind of contained local compression trial could be a useful strategy for dealing with the malignant uncontrollable bleeding from the fragile aortic tissue or root area after acute dissection or aortic root repair.
在A型急性主动脉夹层（AAD）修复或改良Bentall手术后，脆弱的夹层组织或主动脉根部区域吻合部位出现难以控制的出血，对心脏外科医生来说是一种危急情况。术后护理通常需要大量输血，并整夜对患者进行严格监测，随后进行再次手术以控制出血。在两例术后出血无法控制的病例（A型AAD远端吻合部位出血和改良Bentall手术瓣膜植入部位出血）中，我们使用牛心包对心脏上半部分进行局部包裹压迫，从右心室上部到无名静脉上方，并封闭横窦两侧。尽管两天后两例患者均进行了再次手术以取出填塞物，但重症监护病房的术后病程非常顺利，几乎不需要输血。这种局部包裹压迫尝试可能是处理急性夹层或主动脉根部修复后脆弱主动脉组织或根部区域恶性难以控制出血的一种有用策略。
