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[Left heart bypass using a centrifugal pump as an adjunct measure for surgery of thoracic descending aorta]
I Yamagishi1, R Kuribayashi, T Sakurada
1Department of Cardiovascular Surgery, Akita University School of Medicine.
Insights
Left heart bypass (LHB) effectively supports thoracic descending aortic aneurysm surgery by maintaining distal perfusion and reducing bleeding. However, it may fail during acute heart failure, necessitating alternative bypass methods for vulnerable patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Aneurysm Repair
Background:
- Thoracic descending aortic aneurysm repair presents surgical challenges.
- Maintaining adequate distal perfusion during aortic cross-clamping is critical.
- Left heart bypass (LHB) is explored as an adjunct surgical technique.
Observation:
- LHB was utilized in 8 patients undergoing thoracic descending aortic aneurysm surgery.
- Distal perfusion pressure was maintained above 50 mmHg during aortic cross-clamping.
- Hemodynamics remained stable in 7 out of 8 cases.
Findings:
- LHB facilitated adequate distal perfusion and proximal decompression in most cases.
- Intraoperative bleeding was reduced with the use of LHB.
- One patient experienced acute heart failure due to coronary insufficiency, requiring cardiopulmonary bypass.
Implications:
- LHB is a viable adjunct for thoracic descending aortic aneurysm surgery, improving hemodynamic stability and reducing blood loss.
- Careful patient selection is crucial, as LHB may not suffice in cases of acute heart failure.
- Alternative strategies like femorofemoral bypass should be considered for patients with pre-existing heart conditions to prevent distal hypoperfusion.
Abstract:
We have employed left heart bypass (LHB) using a centrifugal pump with heparin coated tubes as an adjunct measure for surgery of thoracic descending aortic aneurysm in 8 cases. During aortic cross-clamping, LHB was controlled to maintain the distal pressure above 50 mmHg. In 7 cases, hemodynamics were stable and no complication occurred in relation with this method. However, acute heart failure due to coronary insufficiency occurred in one patient, and subsequent cardiopulmonary bypass was required to maintain systemic circulation. LHB provides adequate distal perfusion and proximal decompression in most cases, and it has also contributed to diminution of intraoperative bleeding. However, LHB can not maintain distal perfusion when acute heart failure occurs, which indicates that we have to select another adjunct measures, such as femorofemoral bypass to avoid distal hypoperfusion in cases with heart diseases.