Joachim Schoellhorn

Endoscopic treatment for delayed cardiac tamponade.

Cardiac tamponade occurring during the late postoperative period after open-heart surgery is an extremely serious complication. One surgical therapy is a finger dissection through subxiphoid incision. The main limitation is an incomplete view into the pericardial sac. To make subxiphoid exploration more effective, we developed a novel technique of endoscope-assisted removal of delayed cardiac tamponade through subxiphoid pericardiotomy. Surgery was performed under optical guidance of an endoscopic retractor routinely used for harvesting saphenous veins for bypass grafting. After the subxiphoid pericardiotomy, we introduced the endoscopic retractor into the pericardial space, and the haematoma was completely evacuated using a suction apparatus and endoscopic forceps. Between January 2008 and March 2009, three patients underwent endoscope-assisted removal of late cardiac tamponade. The haematoma was completely removed without re-sternotomy. No bleeding or tamponade occurred following the procedure. An endoscopic approach for treating late cardiac tamponade provides the advantages of minimally invasive surgery through subxiphoid pericardiotomy combined with an optimal surgical perspective. This novel technique permits exploration of the pericardium and helps prevent new wounds.

An improved technique for aortic anastomosis: Graft telescopic inversion

Different anastomotic options have been described for reconstructive prosthetic techniques on the aorta. Problems associated with aortic surgery are usually caused by the degeneration of aortic tissues because of dissection, aneurysm, or atherosclerosis. Relevant complications include anastomotic side bleeding, chronic false aneurysms, and dissection of the remaining aorta. We have developed an anastomotic technique that involves inverting the graft at the proximal and distal ends and reinforcing with a felt strip on the external border of the aortic wall.

Modified perfusion strategy and aortic arch debranching in complicated acute aortic dissection type A: a bridge to definitive endovascular therapy.

INTRODUCTION Patients with acute aortic dissection type A (AADA) with aortic arch and supra-aortic vessel involvement have a higher postoperative stroke prevalence and risk of later aortic arch aneurysm development. CASE REPORT We report a case of AADA with involvement of supraaortic arteries, complicated by cerebral malperfusion. The ascending aorta was replaced using bilateral antegrade cerebral perfusion through side-grafts attached to both carotid arteries, which were subsequently used as aorto-bi-carotid bypass. One year later, the diameter of aortic arch increased to 5 cm. The endovascular treatment of aortic arch was easily performed since debranching was already almost complete. CONCLUSIONS Immediate bilateral carotid artery inflow and subsequent aorto-bi-carotid bypass is a safe way to prevent cerebral malperfusion in the setting of complicated AADA.A potential benefit of this technique is almost complete debranching that facilitates an endovascular arch replacement.