Surgical treatment with deep hypothermia for thoracic aortic aneurysm in a patient with renal transplantation

An increasing number of patients have undergone aortic reconstruction, exposing the transplanted kidney to ischemic injury. A 58-year-old male underwent renal transplantation previously. A thoracic aortic aneurysm (TAA) of the distal aortic arch was identified. His renal function was poor due to chronic rejection. The TAA was exposed by a left anterolateral thoracotomy through the 4th intercostal space, and cardiopulmonary bypass established with canulation of the left femoral artery and vein. Deep hypothermic circulatory arrest with retrograde cerebral perfusion was adopted at a rectal temperature of 20 degrees C, and distal arch replacement was successfully performed. Prednisolone was administered intravenously for perioperative immunosuppression. Poor renal function recovered to the preoperative level. No other complications occurred. Perioperative renal graft protection, immunosuppression and infection control are mandatory for surgical treatment in patients with TAA after renal transplantation.