SURGICAL RESULTS FOR THORACOABDOMINAL ANEURYSM BY MODIFIED DEBAKEY METHOD USING CENTRIFUGAL BIOPUMP AND RENAL CRYOPRESERVATION

Background. In this paper, we report the surgical results of our DeBak ey and Crawford combined method. Methods. From 1985 to 1995, 22 consec utive patients with thoraco-abdominal aneurysms underwent a modified D eBakey and Crawford combined procedure to minimize the ischemic time f or the spinal cord and visceral organs. The extent of aneurysm as clas sified 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 dista l anastomosis was performed above the bifurcation under partial aortic clamping, and this was followed by proximal anastomosis, During the e nd-to-end proximal anastomosis, a Gott shunt tube or heparinless left heart bypass was used. In two patients, left renal artery had been pre viously reconstructed by a saphenous vein graft extending from the lef t common iliac artery. Then aneurysm was opened, acid the right renal artery and superiors mesenteric artery were perfused with cold blood. In two patients, partial cardiopulmonary bypass and selective perfusio n were performed. In eight patienti, renal artery, celiac artery, supe rior mesenteric artery, and intercostal artery were reconstructed with a branch graft. Results. No patient died within 30 days of surgery, h owever, one patient died of acute myocardial infarction (POD 54) and a nother of ventricular fibrillation during hemodialysis (POD 60). Posto perative complications included paraplegia, and renal failure requirin g dialysis each in two patients. Postoperative angiography revealed 18 /19 (94.7%) of grafts were patent. Conclusions. In conclusion, by usin g different techniques for spinal cord and visceral protection, includ ing the Gott shunt, Biomedicus pump, renal cryopreservation, and separ ate revascularization of viscera and intercostal arteries, good result s could be obtained.