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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 659-664, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
NT Kouchoukos, TH Wareing, H Izumoto, W Klausing and N Abboud
Resection of aneurysms of the entire descending thoracic aorta and segments
of the abdominal aorta is associated with a substantial incidence of spinal
cord ischemic injury, particularly in patients with aortic dissection.
Since hypothermia has a protective effect on spinal cord function, we
evaluated a technique of total cardiopulmonary bypass with periods of
hypothermic circulatory arrest and low flow (rectal/bladder temperatures of
15 degrees to 19 degrees C) in five patients requiring replacement of the
entire descending thoracic and the upper abdominal aorta and judged to be
at high risk for the development of spinal cord injury. All patent lower
intercostal and lumbar arteries were preserved or reimplanted during the
hypothermic interval. There was one hospital death. None of the four
survivors had a new spinal neurologic deficit, renal or cardiac
dysfunction, or required reoperation for bleeding. Transfusion of blood
products was not excessive. Severe pulmonary dysfunction necessitating
tracheostomy occurred in one patient and contributed to his death 7 weeks
postoperatively. The remaining three patients are well 8 to 36 months
postoperatively. This initial experience suggests that hypothermic
perfusion and circulatory arrest can be safely implemented in selected
patients who require extensive aortic resections and who are at substantial
risk for the development of spinal cord injury. Further evaluation of this
technique is warranted.
ARTICLES
Elective hypothermic cardiopulmonary bypass and circulatory arrest for spinal cord protection during operations on the thoracoabdominal aorta
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo.
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