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Extracorporeal circulation for great vessels surgery: a review of 131 cases
1Beijing Heart, Lung and Blood Vessel Medical Center, Anzhen Hospital, People's Republic of China.
Insights
This study shows that tailored bypass methods improve outcomes in major aortic aneurysm surgery. Specific techniques for ascending and descending aorta repairs reduced mortality rates in complex vascular cases.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Aneurysm Repair
Background:
- Major vascular surgery, particularly for aortic aneurysms, presents significant challenges.
- Optimizing bypass strategies is crucial for improving patient outcomes and reducing complications.
Purpose of the Study:
- To evaluate the effectiveness of different bypass methods tailored to the location of aortic aneurysms.
- To determine if location-specific surgical approaches enhance results in major vascular operations.
Main Methods:
- Retrospective analysis of 131 major vascular surgery cases, focusing on ascending and descending aortic aneurysms.
- Application of continuous retrograde coronary sinus perfusion for cardiac protection in ascending aortic aneurysm repair.
- Utilizing deep hypothermic circulatory arrest and retrograde cerebral perfusion for aortic arch dissections.
- Employing left heart bypass for descending aortic aneurysms to prevent organ ischemia.
Main Results:
- Ascending aortic aneurysm repair (93 cases) had an 8.6% mortality rate (8/93) with improved cardiac protection.
- Descending aortic aneurysm repair (34 cases) showed an 8.8% mortality rate (3/34) using left heart bypass.
- Extended safe circulatory arrest time to 81 minutes in aortic arch cases with deep hypothermia and cerebral perfusion.
Conclusions:
- Tailored bypass strategies based on lesion location can improve results in complex aortic aneurysm surgery.
- Advanced perfusion techniques enhance cardiac and cerebral protection during aortic repair.
- The study supports individualized approaches for better outcomes in major vascular interventions.
Abstract:
A retrospective analysis of 131 cases of major vascular surgery, mainly aneurysms of the ascending and descending aorta, was undertaken to determine whether use of different bypass methods chosen according to location of the individual lesions resulted in improved results. For the 93 cases of ascending aortic aneurysm, the method for cardiac protection was improved by the use of continuous retrograde coronary sinus perfusion with cardioplegic blood. In sixteen cases with dissection involving the aortic arch, deep hypothermic circulatory arrest and continuous retrograde cerebral perfusion through the superior vena cava was employed for brain protection. The safe brain circulation arrest time was thus prolonged to the longest record of 81 minutes. Among the group of 93 cases, there were four operative and four hospital deaths, giving a mortality rate of 8.6% (8/93). For the 34 cases of descending aortic aneurysms, left heart bypass was employed to avoid ischemia of the heart, lungs, brain, and the abdominal organs; the operative mortality rate was 8.8% (3/34). In three cases of interrupted aortic arch, separate upper and lower body perfusion under deep hypothermia with low flow rate perfusion for the upper body provided the necessary conditions for radical surgery. In one patient with Budd-Chiari syndrome, a total corrective surgery was achieved under right heart bypass.