Continuous Selective Cold Perfusion in Thoracoabdominal Aneurysm Repair

Abstract

Fifteen patients with a mean age of 57 ± 17 years underwent thoracoabdominal aortic aneurysm repair under continuous selective blood perfusion of the intercostal and visceral arteries. Three aneurysms were Crawford type I, 6 were type II, and 6 were type III. Surgery was performed on an emergency basis in 5 cases. All operations were carried out using distal perfusion with mild hypothermia (> 32°C) in 13 cases and deep hypothermia (< 20°C) in 2 cases when a proximal clamp was undesirable. During aortic replacement, the intercostal arteries between the eighth thoracic and first lumbar vertebrae and the visceral arteries were reconstructed separately with a prosthetic graft under selective cold blood perfusion (22°C to 26°C). Flow was maintained above 100 mL·min⁻¹. The durations of operation, selective intercostal and visceral perfusion, and distal perfusion were 9 ± 2 hours, 70 ± 35 minutes, and 170 ± 80 minutes, respectively. There was one operative death (mortality, 6.7%) due to respiratory failure and one case of delayed paraparesis. There was no paraplegia, acute hepatorenal failure, or bowel ischemia postoperatively. This experience suggests that continuous selective cold blood spinal and visceral perfusion during thoracoabdominal aneurysm repair can provide adequate organ protection.