Left Atrial to Femoral Artery Full Cardiopulmonary Bypass: A Novel Technique for Descending and Thoracoabdominal Aortic Surgery
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Published on: August 16, 2021
Dimitra Papanikolaou1, Chris Savio1, Mohammad A Zafar1
1Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.
Insights
This study introduces left atrial-femoral artery (LA-FA) cardiopulmonary bypass (CPB) with an oxygenator for aortic surgery. This novel approach improved patient outcomes, reducing blood transfusions and mortality compared to traditional methods.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Anesthesiology
Background:
- Traditional left atrial-femoral artery (LA-FA) bypass without an oxygenator is standard for descending and thoracoabdominal aortic (DTAA) operations.
- This method aims to mitigate complications associated with aortic cross-clamping.
Purpose of the Study:
- To evaluate the safety and efficacy of performing DTAA replacement using left atrial-femoral artery (LA-FA) cardiopulmonary bypass (CPB) with an oxygenator.
- To compare outcomes with traditional LA-FA bypass without an oxygenator.
Main Methods:
- Fourteen consecutive patients underwent DTAA replacement utilizing LA-FA CPB with a full CPB machine, including an oxygenator.
- Pulmonary vein and femoral artery (or distal aorta) were cannulated.
- Data were compared to 50 patients who received traditional LA-FA bypass without an oxygenator.
Main Results:
- The CPB group demonstrated excellent cardiopulmonary stability and oxygenation.
- The CPB group required significantly fewer blood transfusions (2.21 vs. 5.88 units, p < 0.004).
- The CPB group had lower 30-day mortality (7.1% vs. 14%) and no paraplegia cases (vs. 6% in the LA-FA group).
Conclusions:
- Left atrial-femoral artery (LA-FA) cardiopulmonary bypass (CPB) with an oxygenator is a safe and effective technique for DTAA replacement.
- This approach offers potential advantages in hemodynamic stability and hemostasis.
- The findings suggest improved perioperative outcomes compared to traditional LA-FA bypass without an oxygenator.
Abstract:
Left atrial-femoral artery (LA-FA) bypass with a centrifugal pump and no oxygenator is commonly used for descending and thoracoabdominal aortic (DTAA) operations, mitigating the deleterious effects of cross-clamping. We present our initial experience performing DTAA replacement under LA-FA (left-to-left) cardiopulmonary bypass (CPB) with an oxygenator. DTAA replacement under LA-FA bypass with an oxygenator was performed in 14 consecutive patients (CPB group). The pulmonary vein and femoral artery (or distal aorta) were cannulated and the full CPB machine were used, including oxygenator, roller pump, pump suckers, and kinetically enhanced drainage. The CPB group was compared with 50 consecutive patients who underwent DTAA replacement utilizing traditional LA-FA bypass without an oxygenator (LA-FA group). Perioperative data were collected and statistical analyses were performed. All CPB patients maintained superb cardiopulmonary stability. The pump sucker permitted immediate salvage and return of shed blood. Superb oxygenation was maintained at all times. High-dose full CPB heparin was reversed without difficulty. The CPB group required markedly fewer blood transfusions than the LA-FA group (2.21 vs. 5.88 units, p < 0.004). The 30-day mortality rate was 7.1% ( n = 1) and there were no paraplegia cases in the CPB group versus 7 (14%) deaths and 3 (6%) paraplegia cases in the LA-FA group. Traditional LA-FA bypass without an oxygenator avoids high-dose heparin. In the present era, heparin reversal is more secure. Our experience finds that the novel application of LA-FA CPB with an oxygenator is safe and suggests improved hemodynamics (immediate return of shed blood) and a hemostatic advantage (avoidance of loss of coagulation factors in the cell saver).
