Retrograde aortic and selective organ perfusion during thoracoabdominal aortic aneurysm repair

Abstract

To evaluate the possible prevention of renal and intestinal ischaemia during surgery of thoracoabdominal aortic aneurysms (TAAA) by use of retrograde and selective organ perfusion. Prospective study. Thirty-three consecutive patients underwent TAAA repair, six of whom had a previous type B dissection: 14 patients (35%) had type I TAAA, 12 patients type II (32%), three patients type III (15%) and four patients type IV (18%). Mean age was 61 years (range 22-84 years). In patients with type I TAAA, retrograde aortic perfusion was performed by means of a left atrium femoral artery bypass or partial cardiopulmonary bypass. In type II, III and IV the same procedure was performed; however, following cross-clamping and opening of the abdominal aorta, the coeliac trunc, superior mesenteric and both renal arteries were selectively perfused with four Pruitt-catheters (9 Fr.), connected as an octopus to the extracorporal circulation. All patients survived the surgical procedure. The minimal volume flow through each octopus catheter was 60 ml/min. Urine output was uninterrupted in all patients, irrespective of the aortic cross-clamp time. Only one patient (3%), who already had renal insufficiency, developed renal failure. Total in-hospital mortality was 15%, paraplegia occurred in 12%. Retrograde aortic and selective organ perfusion is a safe technique and can prevent ischaemic renal and intestinal damage during cross-clamping of the aorta in thoracoabdominal aneurysm surgery.