Use of Left Heart Bypass in the Surgical Repair of Thoracoabdominal Aortic Aneurysms
| Autor: | Ruben P.H.M. Hamerlijnck, Marc A.A.M. Schepens, Freddy E.E. Vermeulen, Jo J.A.M. Defauw |
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| Rok vydání: | 1995 |
| Předmět: |
Heart Bypass
Left Male medicine.medical_specialty medicine.medical_treatment Aortic aneurysm Postoperative Complications Renal Dialysis Risk Factors Internal medicine medicine Humans Heart bypass Renal Insufficiency Risk factor Dialysis Aged Retrospective Studies Univariate analysis Aortic Aneurysm Thoracic business.industry Mortality rate General Medicine Middle Aged medicine.disease Surgery Survival Rate Cardiology Female Cardiology and Cardiovascular Medicine business Paraplegia Aortic Aneurysm Abdominal Abdominal surgery |
| Zdroj: | Annals of Vascular Surgery. 9:327-338 |
| ISSN: | 0890-5096 |
| Popis: | The purpose of this study was to assess the usefulness of left heart bypass in thoracoabdominal aortic aneurysm surgery. Data from 50 patients who underwent thoracoabdominal aortic aneurysm repair between July 1987 and October 1993 were retrospectively reviewed. In all of them a left heart bypass (left atrium to left femoral artery) with a centrifugal pump (without systemic heparinization) was used. Patient-, disease-, and operation-related variables were analyzed using univariate methods. There were no intraoperative deaths. The in-hospital mortality rate was 8% (n = 4). Survival rates were 77% (+/- 6.5) at 2 years and 62% (+/- 8.7) at 5 years. Renal failure requiring dialysis occurred in five (10%) patients and paraplegia in five (10%). Sixteen (32%) patients had respiratory insufficiency requiring prolonged (8 days) ventilation. After univariate analysis, the risk factors for developing a need for postoperative dialysis were found to be the preoperative creatinine level (p = 0.002) and the presence of preoperative arterial hypertension (p = 0.018). A history of peripheral vascular occlusive disease (p = 0.008) was an important risk factor for predicting late death. No factors retained significance in the univariate analysis of hospital deaths and postoperative paraplegia. Renal and spinal ischemic times were substantially reduced in comparison to the theoretic times calculated if cross-clamping had been used. Bypass-related complications were completely absent. The use of a left heart bypass during thoracoabdominal aortic aneurysm surgery may not reduce the global complication rate; the results were similar to those achieved using simple cross-clamping. However, this technique appears to be the method of choice for protecting organ systems at risk during difficult repairs. |
| Databáze: | OpenAIRE |
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