Application Of Modified Peri-graft To Right Atrial Shunt For Uncontrollable Hemorrhage After Aortic Surgery

Objectives:To introduce a new technique, which can be applied to control intractable bleeding after ascending aorta surgery and aortic arch surgery.Methods:After analyzing 232 patients who received aortic surgery from January 2006 to December 2015,10 out of them along with another patient underwent aortic valve replacement used the modified peri-graft to right atrial shunt. We studied the 11 patients’pre-operative situations, surgical techniques, and post-operative complications to show the feasibility and effectiveness of our new hemostatic technique.Results:In all 11 patients,4 patients died after the surgery (2 of the patients died from renalfailure,1 of them died from cerebral infarction, and the last one died from circulatory failure and multiple organ failure),2 patients received re-operation and used the modified perigraft to right atrial shunt to control bleeding successfully,1 patients got liver and renal failure and underwent CRRT therapy. Even combined with complications such as liver damage, renal failure, ischemic cerebrovascular disease and pulmonary infection, all of the other 7. patients were released from hospital.Conclusions:If an intractable bleeding is encountered after the administration of protamine, thrombotic agents, and all other surgical techniques, or a discrete bleeding site cannot be found, our modified peri-graft to right atrial shunt by using autologous pericardium can be adopted as a last resort. Our original operation could be used in patients whose aortic wall was totally removed and those who received the aortic arch surgery. Owing to its numerous complications, this operation is not recommended as a common practice.