Chapter 1891: with translation of chapter title

Currently, treatment for DeBakey type I aortic dissection aneurysm mainly involves Shou Bing replacement of artificial Blood Vessel.

Because the patient's Marfan syndrome etiology cannot be eradicated and distal residual lesions may still progress, after ascending aortic replacement Shou Bing there is a high possibility of recurrence.

It is estimated that Doctor Rudy had already anticipated this, and he urged his wife to go to King's Hospital for examination immediately if any discomfort appeared.

So this onset was detected early; blood pressure control should have already begun in the ICU to prevent further deterioration, awaiting the next treatment.

One troublesome aspect of Marfan syndrome is that the medium layer of all major Blood Vessels shows cystic necrosis pathology; even if this Shou Bing succeeds, no one can predict when the next episode will occur.

Doctor Rudy continued to say the results of various lab tests; he knew them inside out. Zheng Ren did not speak, merely pondered.

After getting in the car, Su Yun asked: 'Boss, the Shou Bing requires splitting the sternum right in the middle; it's very difficult.'

Zheng Ren understood his meaning.

This is one of the key points and difficulties of the Shou Bing.

Generally speaking, for a repeat Shou Bing, the approach should be the same as the original entry point of the first Shou Bing, so that the patient suffers less damage.

Moreover, for aortic arch replacement Shou Bing, splitting the sternum is almost the only approach; other incisions give limited Operating Field.

But the healed sternum Bone has thick callus; to split it alongside, the sternal saw slips… and then Tragedy strikes.

If it were an ordinary Shou Bing, changing the incision would suffice; but for aortic arch replacement Shou Bing, one cannot make do, and must choose the opening with the greatest visibility.

Zhao Yunlong's idea of performing aortic arch stent grafting via thoracoscopy is still just a thought; who knows when it could actually be researched and realized.

However, during a repeat Shou Bing when splitting the sternum longitudinally, the heart, especially the right atrium, may suffer secondary injury bleeding or aortic Artery aneurysm rupture leading to massive hemorrhage, with a very poor prognosis.

This is based on experience; it seems Su Yun has performed similar Shou Bing before, with average outcomes.

Zheng Ren nodded and said: 'I'll handle the approach; that's not difficult. The difficulty lies afterward; I've considered several methods. I think the way of heparinization followed by cooling is relatively safe.'

'Heparinization, first cooling?' Su Yun was stunned for a moment.

This line of thought is somewhat bizarre.

Moreover, achieving this requires extremely high speed of the Shou Bing.

When the body's blood undergoes heparinization, it faces multiple complications; a patient rescued in the EICU a couple of days ago is one example.

'No, it differs from the usual Shou Bing.'

'How to do it?'

'First heparinize, then cannulate via the right subclavian Artery or femoral Artery and Vein, proceed with extracorporeal circulation and cooling. At this point, opening the chest can reduce the chance of heart or Blood Vessel rupture, and also facilitate separation and exposure of mediastinal adhesions during the repeat Shou Bing.' Zheng Ren said.

'Um…'

'First cooling…'

'After cooling, the whole body's organs, including the heart, will suffer a certain impact. In other words, the speed of splitting the sternum and opening the mediastinum must be sufficiently fast; an estimate of 2-3 Minutes is the limit.'

However, Zheng Ren's suggestion also seems like a line of thought, and Su Yun followed it and thought further.

Unconventional Shou Bing is not for show.

Why do fixed Shou Bing protocols exist? Because countless surgeons, through constant clinical Shou Bing exploration, have verified a certain path as correct using numerous Shou Bing failures.

Once an unconventional Shou Bing is adopted, huge risks will be faced.

But sometimes the actual situation forces doctors to choose unconventional means to complete the Shou Bing.

But compared to directly splitting the sternum, the Boss's approach seems to have fewer complications. No wonder he had Lao He and Yi Ren come together; only a team that has worked together many times can shorten this time to the limit.

'Marfan syndrome is very difficult to handle.' Su Yun sighed.

'Hmm, I've thought about it, during the Shou Bing… I go, I forgot!' Zheng Ren suddenly slapped his thigh.

'What did you forget?' Su Yun asked in surprise.

Zheng Ren did not answer immediately, but instead concentrated his thoughts for a moment, then finally sighed.

'What's wrong? You look like you're in agony; can't you handle the Shou Bing?' Su Yun asked.

'No.' Zheng Ren said: 'I think that the pathological change of medium-layer necrosis in the major Artery caused by this congenital Marfan syndrome should be addressed during the Shou Bing by using a stent to prop it up, to avoid similar problems.'

'……'

'A second sternotomy is still okay, but a third would probably be too much for the patient.' Zheng Ren spoke bluntly.

'During the Shou Bing? First do aortic replacement, then also place a stent?' Su Yun asked.

'Hmm.' Zheng Ren nodded: 'Fugui'er can't come; there's still Shou Bing to be done at home, and neither he nor Lao Liu can move.'

So that's how it is.

'The standard of King's Hospital is not bad.' Su Yun said: 'We can use their doctors to place the stent.'

'That's all we can do.' Zheng Ren said: 'You should bring Lao Zhao; during the Shou Bing, if any problem arises, you go place the stent, and I and Lao Zhao will perform the Shou Bing.'

Su Yun's face twisted all of a sudden.

'Boss, I am a Thoracic doctor!' Su Yun complained.

'Lao Zhao can't do the intervention; if I do it, can you guarantee that I and Lao Zhao will complete the Shou Bing smoothly?' Zheng Ren asked.

'……' Su Yun recalled the Shou Bing process; can she herself perform an unconventional Shou Bing?

Forget it.

Let's just do it as the Boss said.

Seeing Su Yun fall silent, Zheng Ren smiled and said: 'It's fine; I'll check the situation then and try not to delay your study of the Shou Bing.'

'Study?' Su Yun said contemptuously.

'If you can't do it, it's not studying; or do you still want me to teach you the Shou Bing?' Zheng Ren retorted offhand.

For this kind of exchange, Su Yun has no chance of winning.

After all, if she can't handle the Shou Bing herself, Zheng Ren's retort is always spot-on.

'What about the anastomosis?' Su Yun abruptly changed the subject, mentioning the key point of the next Shou Bing.

'I think that to reduce complications of the anastomosis, the length of the diseased aortic aneurysm lesion excised during the Shou Bing should be sufficient.'

'It is necessary to excise the ruptured opening to ensure that the Blood Vessel anastomosis occurs on normal Blood Vessel wall tissue. At the same time, to increase the strength of the Blood Vessel anastomosis, one should adopt the method of reinforcing the entire circumference of the aortic anastomosis end with dense felt strips inside and out. This both increases the strength of the anastomosis and ensures complete sealing of the Blood Vessel dissection.'

"The method of reinforcing the anastomotic end of the aorta circumferentially with dense felt strips, both inside and outside, is difficult." Su Yun said.

"It's fine, I'm here."

Su Yun didn't speak, just glanced at Zheng Ren. His simple and honest face seemed to have a sheen, making people feel trustworthy.

Su Yun waited a long time before saying: "Well, regarding the surgery, you seem to have thought it through thoroughly."

"Also, there's one more thing: brain protection under low-temperature extracorporeal circulation." Zheng Ren said, "I have an idea, but I still want to ask Lao He for his opinion."