Descending Thoracic Aorta Aneurysmectomy: Left-Left Centrifugal Pump versus Simple Clamping Technique

Abstract

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. Paraplegia occurred in one patient (3%) in the centrifugal pump group and in one (10%) in the simple clamping group (P= n.s.). The overall in-hospital mortality rate was 9%, with 71% of all deaths occurring in patients who had an emergency repair of the aneurysm. The cumulative 5-year survival rate was 72% in the centrifugal pump group and 84% in the simple clamp group (P = n.s.). The results confirm that patients offered centrifugal pump support are better stabilized metabolically, suggesting that spinal cord perfusion is improved.

Keywords

descending thoracic aorta aneurysm left-left centrifugal pump bypass distal perfusion

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