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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Simultaneous individually controlled upper and lower body perfusion for valve-sparing root and total aortic arch
Philip Fernandes1, Rick Mayer, Corey Adams
1Clinical Perfusion Services, Cardiac Care, London Health Sciences Centre, London, Ontario, Canada. Philip.fernandes@lhsc.on.ca
The Journal of Extra-Corporeal Technology
|March 16, 2012
Summary
Simultaneous perfusion during aortic surgery protects organs. This "cold head/warm lower body" technique minimizes metabolic debt and improves patient outcomes after extensive aortic resection.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Anesthesiology
Background:
- Extensive aortic resection, particularly for mega-aortic syndromes, often involves hypothermic circulatory arrest.
- This traditional approach carries risks of mesenteric and systemic ischemia due to circulatory arrest.
- Current strategies focus on myocardial and cerebral protection, but visceral organ protection remains a challenge.
Observation:
- A novel perfusion strategy was employed, delivering differential flow rates and temperatures.
- The technique involved 25°C perfusion to the head/upper body and 30°C perfusion to the lower body/mesenteric organs.
- This was achieved via right axillary and right femoral arterial grafts, respectively.
Findings:
- Simultaneous mesenteric, systemic, cerebral, and myocardial perfusion was successfully implemented.
- The "cold head/warm lower body" perfusion strategy effectively minimized ischemic debt.
- Metabolic derangements were rapidly reversed, suggesting improved organ protection.
Implications:
- This innovative perfusion technique offers a potential method to improve perioperative outcomes in complex aortic surgeries.
- It highlights the benefits of targeted organ perfusion in mitigating ischemia during circulatory arrest.
- Further research could validate this approach for broader application in aortic disease management.
