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J Thorac Cardiovasc Surg 1994;107:1237-1243
© 1994 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

Resection of aortic aneurysms without aortic clamp technique with the aid of hypothermic total body retrograde perfusion

Nagoya, Japan

From the Department of Thoracic Surgery, Nagoya University School of Medicine, Nagoya, Japan.

Received for publication May 21, 1993. Accepted for publication Sept. 27, 1993. Address for reprints: Kenzo Yasuura, MD, Department of Thoracic Surgery, Nagoya University School of Medicine, Tsurumai-chou 65, Shouwa-ku, Nagoya, Japan.

Abstract

Aneurysms involving either the aortic arch or the proximal descending thoracic aorta in five patients were resected with the aid of profound hypothermic total body retrograde perfusion. Traditional surgical management of the aortic arch and the descending thoracic aorta necessitates clamping of the aorta. However, this technique may be associated with rupture or atheroembolism. Rupture occurring at the clamping site may be difficult to repair. Atheroembolism to the brain compromises the neurologic system, and multiple organ embolism is associated with disseminated intravascular coagulopathy. Atheroembolism in cardiovascular surgery has become increasingly prevalent. It is necessary to prevent clamp injuries and to preserve the function of the vital organs, such as the brain, heart, and liver, during aortic reconstruction. We applied a total body retrograde perfusion technique to operations for aortic aneurysms. Total body retrograde perfusion consists of cerebral protection by continuous perfusion through the superior vena cava, intermittent retrograde coronary perfusion through the coronary sinus, and continuous abdominal visceral perfusion through the inferior vena cava. It can yield a relatively bloodless operating field without the need for aortic clamping. We believe this new adjunct offers excellent results in the surgical treatment of aneurysms of the aortic arch or adjacent structures. (J THORACCARDIOVASCSURG1994;107:1237-43)

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