Descending thoracic aorta aneurysmectomy: left-left centrifugal pump versus simple clamping technique.
Forty-six patients who had had an elective repair of a descending thoracic aortic aneurysm were reviewed, in order to investigate the efficacy of support by a centrifugal pump on distal organ perfusion and spinal cord protection during cross-clamping of the thoracic aorta. Two concurrent groups were analysed: 36 patients (78%) were supported by left atriofemoral arterial bypass with a centrifugal pump and 10 (22%) had no distal circulatory support. No patient was fully heparinized. The demographic data and preoperative characteristics of the groups, including location and type of aneurysm, were similar. The mean(s.d.) duration of cross-clamping was 37.8 (16) min in the centrifugal pump group and 42.3(21) min in the simple clamping group. Preoperative haemodynamic and laboratory data were similar in both groups. During cross-clamping, parameters of pH and blood urea varied but were better in the centrifugal pump group; changes from pre-intervention to early aortic cross-clamping time were not significant (pH, P < 0.0006; bases, P < 0.0003). Differences in creatinine values were caused mainly by the change from pre-intervention to the first postoperative day (P < 0.03); this continued throughout the hospital stay. The cerebrospinal fluid pressure measurement indicated a significant difference in time change (P < 0.0001) and mean level over time (P < 0.0002): levels were significantly lower in the centrifugal pump group throughout aortic cross-clamping. Three patients in the simple clamping group and none in the centrifugal pump group (P < 0.02) required cerebrospinal fluid drainage.(ABSTRACT TRUNCATED AT 250 WORDS)
Biglioli
P
P
Department of Cardiac Surgery, Centro Cardiologico I. Monzino Foundation, Milan, Italy.
Spirito
R
R
Pompilio
G
G
Agrifoglio
M
M
Sala
A
A
Arena
V
V
Sisillo
E
E
D001013:Aorta, Thoracic; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001806:Blood Urea Nitrogen; D002555:Cerebrospinal Fluid / Q000502:physiology; D003250:Constriction; D003404:Creatinine / Q000097:blood; D018611:Heart Bypass, Left; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007668:Kidney / Q000502:physiology; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010264:Paraplegia / Q000209:etiology; D011183:Postoperative Complications
D003404:Creatinine