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DOI: 10.1055/s-0029-1247032
Less invasive perfusion techniques may improve outcome in thoracoabdominal aortic surgery
Objective: To compare short term outcome of distal perfusion in thoracoabdominal aortic surgery, using non-occlusive femoral cannulation (mini-circuit) against the occlusive cannulation of the traditional setup using a roller pump.
Material and methods: 120 consecutive patients undergoing thoracoabdominal aortic repair with femoro-femoral distal perfusion from 2005–2008 were included in this retrospective study. The Crawford classification in the groups was: type I (35% vs33.5%), type II (29% vs33.5%), type III (31% vs19%), type IV (0% vs3%), type V (5% vs11%). Cardiopulmonary bypass was established, either using a mini-circuit and non-occlusive femoral cannulation (N=48, groupA) or conventional roller pump and occlusive cannulation (N=72, groupB). For comparison, parameters indicating tissue damage and ischemia (lactate dehydrogenase, creatine kinase, myoglobin, creatinine, GFR) were monitored intra- and postoperatively.
Results: One patient from each group required renal dialysis postoperatively. Myoglobin values were similar in both groups. Creatine kinase was significantly higher in group B (p<0.001). Haemolysis was higher in group B (p=0.005). Both groups achieved a return to preoperative GFR by POD10 with significant higher decrease of GFR within the 10 days in the group B.
Conclusions: The use of mini-circuits for TAAA surgery is safe. As compared to patients undergoing suprarenal clamping for AAA, distal and organ perfusion in TAAA surgery maintains renal function independent of the technical setup. An initial decay of GFR, POD1–4, however seems to be related to intraoperative leg ischaemia and haemolysis caused by occlusive cannulation of the femoral vessels and the roller pump. Whether this has effects on long term outcome, remains to be seen.