Descending aortic aneurysm repair utilizing moderate hypothermia (30° C) in conjunction with left heart bypass

A. M. Clark, S. M. Frank, G. M. Williams, S. Kelly, D. Rivard

Research output: Contribution to journalArticlepeer-review

Abstract

Thoracic and thoracoabdominal aortic aneurysm repair are frequently associated with ischemic paraplegia, renal failure and death. In order to decrease the incidence of ischemic events and allow for a longer aortic cross clamp time, we combined our previous technique of segmental sequential repair, left heart bypass and cerebral spinal fluid drainage in conjunction with moderate hypothermia (30°C). Twenty-seven adult patients underwent elective thoracic (n=6) or thoracoabdominal (n=21) aortic aneurysm repair from January 1992 to September 1993 utilizing this hypothermic technique. A heat exchanger was integrated in the centrifugal left heart bypass circuit to achieve moderate hypothermia (30°C) and regain normothermia (37°C) prior to partial bypass termination. Cannulation for left heart bypass was aorta- femoral artery (n=10) or left atrium-femoral artery (n=17). The surgical technique of segmental sequential repair helps to minimize visceral, kidney and spinal cord ischemia. Among these 27 patients, one developed delayed paraplegia on postoperative day 3 and three suffered postoperative death. The average aortic cross clamp time was 76 ± 7 minutes. Previous studies have demonstrated a significant increase of ischemic morbidity (11-25%) when cross clamp times exceeded 30 minutes. We conclude that the combination of left heart bypass, moderate hypothermia and cerebral spinal fluid drainage allow for a longer duration of aortic cross clamp time and a relatively low incidence of ischemic complications.

Original languageEnglish (US)
Pages (from-to)172-177
Number of pages6
JournalJournal of Extra-Corporeal Technology
Volume26
Issue number4
StatePublished - Dec 1 1994

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Professions (miscellaneous)
  • Cardiology and Cardiovascular Medicine

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