K. Yasuura et al., RESECTION OF AORTIC-ANEURYSMS WITHOUT AORTIC CLAMP TECHNIQUE WITH THEAID OF HYPOTHERMIC TOTAL-BODY RETROGRADE PERFUSION, Journal of thoracic and cardiovascular surgery, 107(5), 1994, pp. 1237-1243
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.