Perfusion method for thoracoabdominal aneurysm repair using the open distal technique

Area of Science:

• Cardiovascular Surgery
• Medical Device Engineering
• Anesthesiology

Background:

• Thoracoabdominal aneurysm repair presents significant perfusion support challenges, including maintaining distal aortic flow and rapid fluid resuscitation.
• Avoiding hypothermia and excessive hemodilution are critical during complex aortic surgeries.

Purpose of the Study:

• To describe a novel bypass circuit and protocol designed to address perfusion support challenges in thoracoabdominal aneurysm repair.
• To evaluate the efficacy and benefits of this custom circuit in a clinical setting.

Main Methods:

• A low-prime bypass circuit was constructed using a centrifugal pump and heat exchanger, primed with normal saline.
• Left atrial-descending aorta bypass was employed, with a cell salvage device for autotransfusion and a rapid infusion device for blood products.
• Shed blood during exsanguination was immediately retransfused; packed cells were washed, and citrate dextrose was used for anticoagulation.

Main Results:

• The custom circuit and protocol were successfully implemented in 50 procedures over 18 months.
• The low-prime circuit effectively reduced hemodilution and associated costs.
• A dedicated connection facilitated rapid retransfusion of shed blood, and minimal anticoagulation strategies reduced coagulopathy.

Conclusions:

• The developed bypass circuit and protocol offer a viable solution for managing perfusion support during thoracoabdominal aneurysm repair.
• This approach enhances patient safety by mitigating hypothermia, hemodilution, and coagulopathy.
• The system demonstrates cost-effectiveness and improved efficiency in managing blood products.