A 68-year-old man had undergone ascending aortic replacement for acute type A aortic dissection. Three months later, he had a new aortic dissection with an ulcer-like projection located in the aortic arch with suspected graft infection. An emergent redo total aortic arch and root replacement was performed because of the coexistence of a fragile aortic root wall. The extensive redo procedure necessitated a very long aortic cross-clamping time (516 min). After 25 min of assisted circulation, he was easily weaned from the cardiopulmonary bypass. Finally, an omental flap was harvested to cover the graft. Postoperative ECG and CK-MB examinations showed no significant myocardial injury. He had no symptoms of heart failure and was discharged after a month of antibiotic therapy. One-year follow-up UCG study revealed no abnormal findings except for signs of pericardial adhesion.
Keywords: Aortic surgery; Cardioplegia; Hypothermia; Prolonged aortic cross-clamping; pH–stat management.