Currently, the treatment for Debakey type I dissecting aneurysm is mainly surgical replacement of artificial blood vessels.
Because the cause of the patient's Marfan syndrome cannot be eradicated and the distal residual disease may still develop further, there is a great possibility of recurrence after ascending aorta replacement.
It is estimated that Dr. Rudy had a premonition of this and told his wife to go to King's Hospital immediately if she felt unwell.
Therefore, the onset of the disease was detected very early, and blood pressure control should have been started in the intensive care unit to avoid further deterioration of the condition and wait for the next treatment.
The troublesome thing about Marfan syndrome is that all major blood vessels throughout the body have pathological manifestations of middle-layer cystic necrosis. Even if the operation is successful, no one can predict when the disease will occur next time.
Dr. Rudy went on to talk about the results of various laboratory tests, of which he was well aware. Zheng Ren didn't speak, just deep in thought.
After getting in the car, Su Yun asked: "Boss, the surgery is to split the sternum, which is very difficult."
Zheng Ren knew what he meant.
This is one of the key points and difficulties of surgery.
Generally speaking, for the second surgery, the approach should be the same as the original approach for the first surgery, so that the patient will suffer less damage.
Moreover, for aortic arch replacement surgery, sternotomy is almost the only approach, and other incisions have limited surgical field.
But when the sternum has grown, the bone callus is very thick. If you try to cut it close to the side, the sternum will slip... and then it will be a tragedy.
If it were an ordinary surgery, just change the incision. However, when it comes to aortic arch replacement surgery, there is no way to make do with it. You can only choose the incision with the largest field of view.
The endoscopic aortic arch catheterization surgery that Zhao Yunlong is considering is just an idea, and he doesn’t know when it will be truly researched.
However, when the sternum is split vertically during the second operation, the heart, especially the right atrium, may suffer secondary damage and bleeding, or the aneurysm may rupture and cause massive bleeding, and the prognosis is very poor.
This is based on experience. It seemed that Su Yun had undergone similar surgery, and the results were average.
Zheng Ren nodded and said: "I'll figure out the approach. It's not difficult. The difficulty lies in the back. I've thought about several methods. Among them, I think heparinization and cooling first are safer."
"Heparinization, cooling down first?" Su Yun was startled.
This idea is a bit bizarre.
And to do this requires extremely high speed of surgery.
When the body's blood is heparinized, it will face various complications. The patients rescued in the EICU two days ago are one example.
"No, it's a little different from usual surgeries."
"How to do it?"
"Heparinization first, intubation through the right subclavian artery or femoral artery and vein, and extracorporeal circulation and cooling. At this time, thoracotomy can reduce the chance of heart or blood vessel rupture, and it is also more conducive to the treatment of mediastinal adhesions during the second operation. Separation and revelation." Zheng Rendao.
Well…
Cool down first…
After cooling down, all organs in the body, including the heart, will be affected to a certain extent. In other words, the speed of splitting the sternum and opening the mediastinum must be fast enough. It is estimated that 2-3 minutes is the limit.
However, Zheng Ren's statement seemed to have the same train of thought, and Su Yun continued to think along Zheng Ren's statement.
Unconventional surgeries are not done for the sake of sensationalism.
Why do fixed techniques exist? It is because countless surgeons are constantly groping for clinical operations and have used countless surgical failures to prove that a certain way is correct.
Once unconventional surgery is adopted, huge risks will be faced.
But sometimes, the actual situation forces the doctor to choose unconventional means to complete the operation.
But compared with directly splitting the sternum, the boss said it seems that there are fewer complications. No wonder he asked Lao He and Yi Ren to come together. Only a team that has cooperated many times can shorten this time to the limit.
"Marfan syndrome is difficult to deal with." Su Yun sighed.
"Well, I've thought about it. During the operation... I'll go and forget it!" Zheng Ren suddenly patted his thigh.
"What did you forget?" Su Yun asked in surprise.
Zheng Ren did not answer immediately, but thought about it carefully, and finally sighed.
"What's wrong? Seeing how painful you are, is it because the surgery can't be performed?" Su Yun asked.
"No." Zheng Ren said: "I think that Marfan syndrome, a congenital disease that causes pathological changes in the middle layer of the aorta, should be propped up with stents during surgery to avoid similar problems from happening again."
“…”
"The second thoracotomy is fine, but the third thoracotomy will probably be enough for the patient." Zheng Ren said bluntly.
"During the operation? Do the aorta replacement first, and then remove the stent?" Su Yun asked.
"Yes." Zheng Ren nodded, "Fugui'er can't come. There is still surgery to be done at home, and neither he nor Lao Liu can move."
So that's it.
"The standard of King's Hospital is not bad." Su Yun said: "You can use their doctors to remove the stent."
"That's all we can do." Zheng Ren said, "You should ask Lao Zhao to come. If there is a problem during the operation, you can remove the stent and Lao Zhao and I will do the surgery."
Su Yun's face suddenly twisted.
"Boss, I am a doctor with a big heart!" Su Yun complained.
"Old Zhao doesn't know how to do intervention. If I do it, can you guarantee that you and Lao Zhao will complete the operation smoothly?" Zheng Ren asked.
"..." Su Yun thought back to the operation process. It was an unconventional operation. Can he do it by himself
never mind.
I did as the boss said.
Seeing Su Yun's silence, Zheng Ren smiled and said, "It's okay. I'll check the situation when the time comes and try not to delay your surgery."
"Study?" Su Yun said contemptuously.
"If you can't do it, then instead of learning, you still have to teach me how to perform surgery?" Zheng Ren retorted casually.
For this kind of confrontation, Su Yun had no chance of winning at all.
After all, he couldn't handle the surgery himself, so Zheng Ren was sure of it.
"What to do about the anastomosis?" Su Yun abruptly changed the subject and talked about the key points of the next surgery.
“I think that in order to reduce anastomotic complications, the diseased aortic aneurysm removed during surgery should be long enough.
The rupture must be removed to ensure that the blood vessels are anastomotic to the normal blood vessel wall tissue. At the same time, in order to increase the strength of the vascular anastomosis, the entire circumference of the aortic anastomosis end should be reinforced with dense felt strips internally and externally. It not only increases the strength of the anastomosis, but also ensures the complete sealing of vascular dissection. "
"The internal and external reinforcement method of dense felt strips around the entire circumference of the aortic anastomosis is very difficult," Su Yundao said.
"It's okay, I'm here."
Su Yun said nothing and just glanced at Zheng Ren. His simple and honest face seemed to be glowing with a layer of luster, making people feel trustworthy.
"Well, you seem to have thought very carefully about the surgery." Su Yun said after a long time.
"One more thing, brain protection under hypothermic extracorporeal circulation." Zheng Ren said, "I have an idea, but I also want to ask Lao He if he has any opinions."