Selective visceral perfusion during thoracoabdominal aortic aneurysm repair.
OBJECTIVE
To evaluate the effectiveness of selective visceral perfusion during repair of an thoracoabdominal aortic aneurysm (TAAA), we compared the postoperative renal and hepatic functions (blood urea nitrogen, serum creatinine, total bilirubin, glutamate pyruvate transaminase) between the two groups with and without perfusion.


METHODS
We operated on 52 patients with TAAA. Among them, the visceral vessels were reconstructed in 22 patients with selective visceral perfusion and in 12 patients without perfusion. The average selective perfusion time was 49.5+/-25.5 min. in the celiac and superior mesenteric arteries and 32.8+/-18.8 min. in the renal arteries. The average perfusion flow rate per each visceral vessel was 155.4+/-97.4 ml/min.


RESULTS
There were five hospital deaths. There was no significant difference between the groups in the postoperative value of four factors. The selective perfusion time for vessel reconstruction in the selective visceral perfusion group was significantly longer than the arterial clamp time for vessel reconstruction in the non-perfusion group (49.5+/-25.5 min. vs. 25.6+/-13.4 min.).


CONCLUSIONS
Our selective visceral perfusion method is not only beneficial for organ protection, but also provides us with the necessary time to reimplant the visceral as well as intercostal or lumbar arteries.
Kuniyoshi
Yukio
Y
Thoracic and Cardiovascular Surgery Division, Department of Bioregulatory Medicine, School of Medicine, University of the Ryukyus, Okinawa, Japan.
Koja
Kageharu
K
Miyagi
Kazufumi
K
Uezu
Tooru
T
Yamashiro
Satoshi
S
Arakaki
Katuya
K
Nagano
Takaaki
T
Mabuni
Katuhito
K
Senaha
Shigenobu
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000784:Aortic Dissection / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000097:blood / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery; D001663:Bilirubin / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D001806:Blood Urea Nitrogen; D002445:Celiac Artery / Q000601:surgery; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007677:Kidney Function Tests; D008111:Liver Function Tests; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery; D008875:Middle Aged; D010477:Perfusion; D012077:Renal Artery / Q000601:surgery; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D014781:Viscera / Q000098:blood supply*
D015415:Biomarkers; D003404:Creatinine; D000410:Alanine Transaminase; D001663:Bilirubin