RETROGRADE AORTIC AND SELECTIVE ORGAN PERFUSION DURING THORACOABDOMINAL AORTIC-ANEURYSM REPAIR

Objectives: To evaluate the possible of renal and intestinal ischaemia during surgery of thoracoabdominal aortic aneurysms (TAAA) by use of retrograde and selective organ perfusion. Design: Prospective study. M aterials: 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 f our patients type IV (18%). Mean age was 61 years (range 22-84 years). Methods: In patients with type I TAAA, retrograde aortic perfusion wa s 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 abdom inal aorta, the coeliac trunc, superior mesenteric and both renal arte ries were selectively perfused with four Pruitt-catheters (9 Fr.), con nected as an octopus to the extracorporal circulation. Results: All pa tients survived the surgical procedure. The minimal volume flow throug h 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 fa ilure. Total in-hospital mortality was 15%, paraplegia occurred in 12% . Conclusions: Retrograde aortic and selective organ perfusion is a sa fe technique and can prevent ischaemic renal and intestinal damage dur ing cross-clamping of the aorta in thoracoabdominal aneurysm surgery.