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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 1998 August;39(4):399-404

lingua: Inglese

Surgical ­results for thor­a­co-ab­dom­i­nal aneu­rysm by mod­i­fied DeBakey method ­using cen­trif­u­gal bio­pump and ­renal cryo­pres­er­va­tion

Yama­shi­ta Ch., Oka­da M., Ata­ka K., Yoshi­da M., Noha­ra H., Aza­mi T., Yama­shi­ta T., Oza­ki N.

From the Department of Surgery, Division II Kobe University School of Medicine, Kobe, Japan


Background. In ­this ­paper, we ­report the sur­gi­cal ­results of our DeBakey and Crawford com­bined meth­od.
Methods. From 1985 to 1995, 22 con­sec­u­tive ­patients ­with thor­a­co-ab­dom­i­nal aneu­rysms under­went a mod­i­fied DeBakey and Crawford com­bined pro­ce­dure to min­i­mize the ischem­ic ­time for the spi­nal ­cord and vis­cer­al ­organs. The ­extent of aneu­rysm as clas­si­fied by Crawford was as fol­lows: ­Group I, 12; ­Group II, 4, ­Group III, 3; ­Group IV, 3. The eti­ol­o­gy of the aneu­rysm was ath­ero­scler­o­sis in 19, cys­tic medi­al necro­sis in 2, and aor­titis in 1. The aneu­rysm was ­approached ­through the spi­ral open­ing meth­od. First, end-to-­side dis­tal anas­tom­o­sis was per­formed ­above the bifur­ca­tion ­under par­tial aor­tic clamp­ing, and ­this was fol­lowed by prox­i­mal anas­tom­o­sis. During the end-to-end prox­i­mal anas­tom­o­sis, a Gott ­shunt ­tube or hep­a­rin­less ­left ­heart ­bypass was ­used. In two ­patients, ­left ­renal ­artery had ­been pre­vi­ous­ly recon­struct­ed by a saph­e­nous ­vein ­graft extend­ing ­from the ­left com­mon ­iliac ­artery. Then aneu­rysm was ­opened, and the ­right ­renal ­artery and super­i­ors mes­en­ter­ic ­artery ­were per­fused ­with ­cold ­blood. In two ­patients, par­tial car­di­o­pul­mo­nary ­bypass and selec­tive per­fu­sion ­were per­formed. In ­eight patien­ti, ­renal ­artery, ­celiac ­artery, super­i­or mes­en­ter­ic ­artery, and inter­cos­tal ­artery ­were recon­struct­ed ­with a ­branch ­graft.
Results. No ­patient ­died with­in 30 ­days of sur­gery, how­ev­er, one ­patient ­died of ­acute myo­car­dial infarc­tion (POD 54) and ­another of ven­tric­u­lar fib­ril­la­tion dur­ing hemo­di­al­y­sis (POD 60). Postoperative com­pli­ca­tions includ­ed par­a­ple­gia, and ­renal fail­ure requir­ing dial­y­sis ­each in two ­patients. Postoperative angio­gra­phy ­revealed 18/19 (94.7%) of ­grafts ­were pat­ent.
Conclusions. In con­clu­sion, by ­using dif­fer­ent tech­niques for spi­nal ­cord and vis­cer­al pro­tec­tion, includ­ing the Gott ­shunt, Biomedicus ­pump, ­renal cryo­pres­er­va­tion, and sep­ar­ate revas­cu­lar­iza­tion of vis­ce­ra and inter­cos­tal arter­ies, ­good ­results ­could be ­obtained.

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