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Thoracoabdominal Aortic Aneurysm Repair: Reducing Adverse Outcome with Left Heart Bypass, Selective Visceral Perfusion and Renal Protection

Carole Hamilton, CCP

Marek P. Ehrlich, MD

Doris Hutschala, MD

Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria

Herbert Koinig, MD

Department of Anesthesia, University of Vienna, Vienna, Austria

Ernst Wolner, MD

Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria

Martin Grabenwoger, MD

Department of Cardiothoracic Surgery, AKH Vienna, Leitstelle 20A, Waehringer Guertel 18-20, 1090 Vienna, Austria

Objective: To report our experience with left heart bypass and selective visceral perfusion for prevention of permanent spinal cord injury and distal organ failure in patients undergoing thoracoabdominal aortic aneurysm repair.

Methods: From April 2001 to March 2002 seven patients were electively operated on with left heart bypass and selective perfusion of the visceral and renal organs at the University Clinic of Vienna, Austria. There were four males (57%) and two females (43%) with a mean age of 70 ± 6 years. Etiology of the aneurysm was a chronic dissection in one patient and athereosclerotic in the remaining five. Crawford classification was I in one patient (14%), II in five patients (86%) and III in one patient (14%). Existing comorbidities were hypertension in all seven patients, coronary artery disease in two patients (29%), chronic pulmonary obstructive disease in two patients (29%), and lung cancer resection and peripheral artery occlusive disease in one patient (14%) each. Two patients had a history of prior aortic aneurysm repair, namely elective repair of the ascending thoracic aorta 2 months before the thoracoabdominal aortic aneurysm repair, and replacement of the infrarenal aorta 12 years previously in another patient.

Results: All patients survived the operation and were discharged after a mean hospital stay of 25 ± 13 days. Adverse outcome occurred in three out of seven patients. One patient with Crawford classification 11 developed acute renal insufficiency, and two patients with class 11 and III showed signs of transient paraparesis, respectively. Mean intraoperative blood loss was 3315 ± 701 ml. On average, 6.7 ± 2.8 units of packed red cells, 10 units of fresh frozen plasma, and 1 unit of platelets were given during the operation. Intensive care unit stay ranged from 2 to 16 days.

Conclusions: The combined usage of left heart bypass, selective visceral perfusion, and renal protection can be recommended as a useful and effective technique in order to minimize adverse outcome in patients undergoing repair of the thoracoabdominal aorta.

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