Descending thoracic aortic aneurysm repair with the aid of partial cardiopulmonary bypass: heparin-coated circuits versus nonheparin-coated circuits.
BACKGROUND
We have performed descending thoracic aortic aneurysm repairs with partial cardiopulmonary bypass, including heparin-coated circuits. The aim of this study was to evaluate (i) the impact of partial cardiopulmonary bypass on distal organ function and surgical outcomes; and (ii) the effectiveness of using heparin-coated circuits for preventing bleeding complications.


METHODS
From July 1980 to June 2004, 309 patients underwent descending thoracic aortic aneurysm repairs using partial cardiopulmonary bypass. Their mean age was 61 years (range 19-81 years). One hundred of the 309 patients underwent repair of descending thoracic aortic aneurysm with heparin-coated circuits. Blood data for renal and hepatic function were collected on the day before the operation and postoperative days.


RESULTS
The in-hospital mortality was 15%. Distal organ dysfunction included spinal cord dysfunction in 2 patients (0.7%) and renal failure necessitating hemodialysis in 15 patients (5%, 15/297: excluded 12 dialysis patients). Multivariate analyses showed that preoperative hemodialysis and emergency operation were risk factors for operative mortality and that emergency operation was a risk factor for requiring hemodialysis. Renal and hepatic function normalized by 2 weeks after surgery. There were no significant differences between the heparin-coated group and nonheparin-coated group in amounts of packed red cells, fresh frozen plasma, and platelets transfused during the procedures.


CONCLUSIONS
Our data showed that partial cardiopulmonary bypass is a safe and effective method for distal perfusion. Using this technique, descending thoracic aortic aneurysm repair can be performed with acceptable mortality and morbidity. However, the superiority of heparin-coated circuits over nonheparin-coated ones was not proved.
Morishita
Kiyofumi
K
Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Central Ward, Sapporo 060-8543, Japan. kmori@sapmed.ac.jp
Kawaharada
Nobuyoshi
N
Fukada
Johji
J
Hachiro
Yoshikazu
Y
Kurimoto
Yoshihiko
Y
Fujisawa
Yasuaki
Y
Saito
Tatsuya
T
Abe
Tomio
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000925:Anticoagulants / Q000008:administration & dosage*; D017545:Aortic Aneurysm, Thoracic / Q000097:blood / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003404:Creatinine / Q000097:blood; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008099:Liver / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000295:instrumentation*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D016896:Treatment Outcome
D000925:Anticoagulants; D006493:Heparin; D003404:Creatinine; D000410:Alanine Transaminase