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Simultaneous upper and lower body perfusion using hypothermia during thoracoabdominal aortic surgery
Yuya Kise1, Yukio Kuniyoshi2, Mizuki Ando3
1Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan. yuya1022@med.u-ryukyu.ac.jp.
Journal of Cardiothoracic Surgery
|November 14, 2023
Summary
Simultaneous upper and lower body perfusion during thoracoabdominal aortic surgery effectively protects organs. This hypothermic technique minimizes spinal cord, brain, and cardiac complications in patients undergoing complex aortic repair.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Aneurysm Repair
Background:
- Open thoracoabdominal aortic aneurysm (TAAA) repair necessitates complex vascular reconstruction strategies.
- Protecting vital organs, including the spinal cord, brain, heart, and lungs, is paramount during TAAA surgery.
- Moderate to deep hypothermia with assisted circulation is a key component of TAAA repair protocols.
Purpose of the Study:
- To evaluate the efficacy of simultaneous upper and lower body perfusion under moderate to deep hypothermia in open TAAA repair.
- To assess the protective effects of this technique on spinal cord, brain, heart, and lung function.
- To determine the safety and outcomes associated with this perfusion strategy.
Main Methods:
- TAAA repair was performed in 18 patients between October 2014 and January 2023 under hypothermia (20-28°C).
- Cardiopulmonary bypass utilized combined upper and lower body perfusion via femoral artery and transapical/descending aorta/left brachial artery.
- The study included various Crawford and Safi classifications of TAAA.
Main Results:
- No spinal cord ischemic injury, brain, or heart complications were observed.
- Ischemic times for critical arteries ranged from 40-124 minutes (mean 75 ± 33 min).
- Low rates of complications (one renal artery occlusion, one infected aneurysm requiring tracheostomy) and no in-hospital deaths were reported.
Conclusions:
- Simultaneous upper and lower body perfusion under moderate to deep hypothermia is effective in preventing spinal cord injury during TAAA surgery.
- This technique also appears to mitigate cardiac and brain complications.
- The findings support the use of this perfusion strategy for improved patient outcomes in complex aortic procedures.
