Less-invasive perfusion techniques may improve outcome in thoracoabdominal aortic surgery

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Medical Devices

Background:

• Thoracoabdominal aortic aneurysm (TAAA) repair requires complex perfusion strategies.
• Distal perfusion aims to protect organs during aortic cross-clamping.
• Current techniques involve traditional roller pumps and occlusive cannulation, potentially causing complications.

Purpose of the Study:

• To compare the short-term outcomes of distal perfusion using a mini-circuit with nonocclusive femoral cannulation versus a traditional setup in TAAA surgery.
• To evaluate the impact of different perfusion techniques on markers of tissue damage and ischemia.

Main Methods:

• Retrospective study of 120 TAAA patients undergoing femoro-femoral distal perfusion.
• Group A (N=48): Mini-circuit (centrifugal pump, low priming volume, heparin coating) with nonocclusive femoral cannulation.
• Group B (N=72): Conventional roller pump with occlusive femoral cannulation.
• Monitored lactate dehydrogenase, creatine kinase, myoglobin, creatinine, and glomerular filtration rate (GFR).

Main Results:

• Creatine kinase and lactate dehydrogenase (hemolysis) were significantly higher in the traditional group (Group B).
• Both groups showed a return to preoperative GFR by postoperative day 10.
• Group B experienced a significantly greater initial decrease in GFR within 10 days.
• Myoglobin levels and the need for renal dialysis were similar between groups.

Conclusions:

• Mini-circuit use for TAAA surgery is safe and effective for distal perfusion.
• Distal perfusion maintains renal function regardless of the technical setup.
• Occlusive cannulation and roller pumps may contribute to leg ischemia, hemolysis, and initial GFR decline.
• Long-term outcomes require further investigation.