RESECTION OF AORTIC-ANEURYSMS WITHOUT AORTIC CLAMP TECHNIQUE WITH THEAID OF HYPOTHERMIC TOTAL-BODY RETROGRADE PERFUSION

Aneurysms involving either the aortic arch or the proximal descending thoracic aorta in five patients were resected with the aid of profound hypothermic total body retrograde perfusion. Traditional surgical man agement of the aortic arch and the descending thoracic aorta necessita tes clamping of the aorta. However, this technique may be associated w ith rupture or atheroembolism:olism. Rupture occurring at the clamping site may be difficult to repair. Atheroembolism to the brain compromi ses the neurologic system, and multiple organ embolism is associated w ith disseminated intravascular coagulopathy. Atheroembolism in cardiov ascular surgery has become increasingly prevalent. It is necessary to prevent clamp injuries and to preserve the function of the vital organ s, such as the brain, heart, and liver, during aortic reconstruction. We applied a total body retrograde perfusion technique to operations f or aortic aneurysms. Total body retrograde perfusion consists of cereb ral protection by continuous perfusion through the superior vena cava, intermittent retrograde coronary perfusion through the coronary sinus , and continuous abdominal visceral perfusion through the inferior ven a cava. It can yield a relatively bloodless operating field without th e need for aortic clamping. We believe this new adjunct offers excelle nt results in the surgical treatment of aneurysms of the aortic arch o r adjacent structures.