Surgery of descending thoracic aortic aneurysms with centrifugal pump support.
Fifty-five patients with descending thoracic aortic aneurysms were operated upon between October 1987 and October 1994. All patients were supported by a centrifugal pump during operation. The mean(s.d.) duration of cross-clamping was 39(13) min. In order to evaluate the efficacy of the centrifugal pump, haemodynamic and metabolic measurements were made on four occasions (before cross-clamping, immediately after cross-clamping and before cross-clamp removal) and again after cross-clamp removal. The haemodynamic data remained stable throughout the procedure: central venous pressure (15(4.6) versus 16(4.8) versus 16(4.6) versus 15(4.6) mmHg; P = n.s.), pulmonary artery pressure (25(6.2) versus 24(5.1) versus 22(5.3) versus 23(4.4) mmHg; P = n.s.), radial systolic pressure (119(19.9) versus 116(25.2) versus 111(25.9) versus 111(20.7) mmHg; P = n.s.) and heart rate (75(12.6) versus 77(14) versus 76(15.6) versus 78(16) beats/min; P = n.s.). The acid-base status deteriorated slowly during surgery. Values before and after cross-clamping were: pH (7.42 (0.04) versus 7.37(0.06); P < 0.05), base excess (-0.67(2.20) versus -3.70(2.50); P < 0.05) and bicarbonates (24(8.9) versus 20(1.9); P < 0.05). The cerebrospinal fluid pressure remained constant: 20(5.7) versus 19(5.9) versus 18(5) versus 19(5) mmHg; P = n.s. Renal function, measured before, and at 1, 3 and 7 days after the operation also remained stable (creatinine: 1.1(0.4) versus 1.2(0.4) versus 1.2(0.4) versus 1.2(0.4); P = n.s.; blood urea nitrogen: 46(18.7) versus 46(18.6) versus 51(24.9) versus 55(27.9); P = n.s.). Step-wise multiple linear regression comparing cerebrospinal fluid pressure against haemodynamic and metabolic data showed that during aortic cross-clamping there was a significant relationship between central venous pressure (P < 0.0013) and arterial pH (P < 0.0148), while before and after cross-clamping multivariate analysis showed a relationship only between central venous pressure and cerebrospinal fluid pressure (P < 0.0035). The results confirm that centrifugal pump support is effective in stabilizing haemodynamics and protecting the kidney during thoracoabdominal aneurysm repair.
Biglioli
P
P
Department of Cardiac Surgery, University of Milan, Centro Cardiologico Hospital-Fondazione Monzino IRCCS, Italy.
Spirito
R
R
Agrifoglio
M
M
Pompilio
G
G
Parolari
A
A
Dainese
L
L
Arena
V
V
Sala
A
A
D000136:Acid-Base Equilibrium / Q000502:physiology*; D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001806:Blood Urea Nitrogen; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology*; D003404:Creatinine / Q000097:blood; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D018611:Heart Bypass, Left / Q000295:instrumentation*; D006439:Hemodynamics / Q000502:physiology*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology; D015996:Survival Rate
D003404:Creatinine