Prolonged cardiopulmonary bypass in patients requiring extensive coronary endarterectomy and reconstruction

Abstract

The technique of coronary endarterectomy and reconstruction is a tedious and time-consuming surgical procedure. A 14cm endarterectomy may be required fora diffusely diseased artery, such as the left anterior descending coronary artery. With accompanying diagonal branches and septal perforators requiring reconstruction, this single vessel procedure may require as long as 90-115 minutes of aortic crossclamp time. Multiple endarterectomies, including the marginal branches of the circumflex system as well as multiple branches of the right coronary system, may consume an additional 100-125 minutes of aortic crossclamp time. In our experience, it is not uncommon for total aortic crossclamp time to exceed 200 minutes. Because of the totally occlusive nature of the coronary atheromatous disease, cardioplegia is impossible to deliver. As a result, the method of intermittent ischaemic arrest has proven, in our experience, to be the technique of choice for myocardial preservation. It has become necessary to develop a perfusion protocol which vvill support a surgical procedure which may require a total of 300 to 420 minutes on cardiopulmonary bypass (CPB).