Percutaneous cardiopulmonary support in surgery for descending thoracic aortic aneurysms

Abstract

There is uncertainty regarding the optimal method of intraoperative management of patients with aneurysm of the descending thoracic aorta. Although the percutaneous cardiopulmonary support (PCPS) was developed for use in patients with severe heart failure, it has been applied during the resection of descending thoracic aortic aneurysms in our department since 1993. The purpose of this study was to retrospectively compare conventional axillo-iliac temporary bypass to PCPS in patients undergoing repair of a thoracic aortic aneurysm. We retrospectively reviewed 18 consecutive patients with thoracic aortic aneurysms who underwent repair between January 1989 and March 1995. There were 10 patients who underwent aneurysm resection using axillo-iliac temporary bypass (Group I) and 8 who underwent resection using PCPS (Group II). The clamp time, bypass time, estimated blood loss and transfusion requirement did not differ significantly between the two groups. The operating and anesthesia times in Group II (390 ± 91 minutes and 598.8 ± 26.3 minutes, respectively) were significantly shorter than those in Group I (514 ± 100 minutes and 821.5 ± 32.5 minutes, respectively). The duration of postoperative intubation, intensive care unit (ICU) stay, and postoperative hospitalization were significantly shorter in Group II (1.6 ± 0.9, 5.3 ± 1.0, and 17.6 ± 5.6 days, respectively) than in Group I (5.0 ± 2.4, 2.8 ± 0.3, and 24.3 ± 4.8 days, respectively). Percutaneous cardiopulmonary support is a useful technique in surgery for thoracic aortic aneurysms. The advantages of this technique over conventional axillo-iliac temporary bypass are shortened operative time, duration of intubation, ICU stay, and postoperative hospitalization. In addition, it is easy to maintain the bypass flow using a centrifugal pump, and to maintain the body temperature using a heating exchanger.