Abad C, Hurle A, Feijoo J, Gomez-Marrero J, Abdallah A
Department of Cardio-Vascular Surgery, Hospital N. S. del Pino, Las Palmas de Gran Canaria, Spain.
Eur J Cardiothorac Surg. 1995;9(9):531-3. doi: 10.1016/s1010-7940(95)80056-5.
The case is presented of a 60-year-old man with previous surgery on the transverse aorta and a pseudoaneurysm of the aortic arch and hemoptysis. The patient was operated upon with cardiopulmonary bypass and cerebral perfusion. The aortic arch was resected preserving a cuff of the aorta containing the three supra-aortic trunks. A bronchial fistula was closed with a pediculated flap of the native arch. A long segment of cryopreserved human aorta (ascending, arch and upper descending thoracic aorta) was inserted in the orthotopic position. The aortic cuff with the supra-aortic vessels was re-inserted onto the allograft. The patient is asymptomatic 2 months after the operation. Aortic homografts are a good alternative in cases with suspected infection or contamination, like this one. Other conditions, such as infected aneurysms, infected grafts, aorto-esophageal fistula and aorto-gastrointestinal fistula, are potentially good candidates for homografting. We believe that this case is the first report of a complete substitution of the aortic arch with a human cryopreserved homograft.
本文介绍了一名60岁男性患者，既往接受过横断主动脉手术，患有主动脉弓假性动脉瘤并咯血。患者在体外循环和脑灌注下接受手术。切除主动脉弓时保留了包含三个主动脉弓上分支的主动脉袖带。用自体主动脉弓带蒂皮瓣封闭支气管瘘。将一段长的低温保存的人主动脉（升主动脉、主动脉弓和胸降主动脉上段）原位植入。将带有主动脉弓上血管的主动脉袖带重新植入同种异体移植物上。患者术后2个月无症状。在疑似感染或污染的病例中，如本例，主动脉同种异体移植物是一种很好的选择。其他情况，如感染性动脉瘤、感染性移植物、主动脉食管瘘和主动脉胃肠瘘，可能是同种异体移植的良好候选者。我们认为，本病例是首例用人低温保存同种异体移植物完全替代主动脉弓的报告。
