Hypothermic thoracic and thoracoabdominal aneurysm operation: a central cannulation technique

Area of Science:

• Cardiovascular Surgery
• Neurosurgery
• Vascular Surgery

Background:

• Surgical repair of descending thoracic and thoracoabdominal aorta carries a risk of spinal cord ischemic injury.
• Hypothermic cardiopulmonary bypass with circulatory arrest is used for spinal cord protection but is complex.

Purpose of the Study:

• To describe an alternative cannulation technique for thoracic and thoracoabdominal aortic surgery.
• To evaluate the safety and efficacy of this technique in protecting the spinal cord.

Main Methods:

• An alternative cannulation technique using right atrial venous return and aortic arch arterial return was employed.
• The procedure involved profound hypothermia and attempted preservation of spinal radicular arteries.
• The technique was used in 6 patients undergoing aortic replacement.

Main Results:

• Four out of six patients recovered well.
• One patient experienced paraparesis despite protective measures, eventually dying of multisystem failure.
• Another patient died of respiratory failure; the remaining four had good outcomes, including one with preoperative ischemic necrosis requiring gut resection.

Conclusions:

• This alternative cannulation technique, combined with profound hypothermia, improves surgical conditions for extensive thoracoabdominal aortic aneurysms.
• Spinal cord injury risk persists, indicating that unfavorable vascular anatomy remains a predominant risk factor despite protective strategies.