title: Combined distal aortic perfusion and balloon occlusion to facilitate the repair of complex thoracic and thoracoabdominal aortic aneurysms.
abstract: We investigated a unique method utilising a Heartport bifurcated arterial cannula and an aortic occlusion balloon to provide both distal perfusion and bloodless, distal arterial exposure during repair of thoracic and thoracoabdominal aortic pathology. Between February 2002 and September 2008, 21 patients underwent thoracic or thoracoabdominal aortic repair with this method. Because of an inability or potential difficulty in achieving distal aortic control secondary to anatomic or technical challenges, a compliant balloon was passed through the accessory arterial channel using fluoroscopic guidance. Adjunctive cerebrospinal drainage was used in all cases. Ballon deployment and satisfactory occlusion was attained in all cases. The overall 30-day mortality rate was 4.75% (1 of 21 patients). Renal failure occurred in one patient (4.75%) and heart failure occurred in two patients (9.5%). Six patients (29%) had pulmonary complications. Transient encephalopathy occurred in two patients (9.5%). Spinal cord neurologic deficit and stroke were avoided in all patients. We recommend the application of this simple method to obtain a bloodless anastomotic field and maintain ongoing distal aortic perfusion in instances where distal control with a clamp is challenging, not feasible or presents the potential for catastrophic intra-operative bleeding.
authors.affiliation: Riverside Methodist Hospital, Columbus, OH 43214, USA. drw379@gmail.com
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Watson
authors.forename: Timothy
authors.initials: T
authors.lastname: Flesher
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D021721:Balloon Occlusion / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D010477:Perfusion / Q000379:methods; D011183:Postoperative Complications; D012086:Reoperation