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Abstract

Background

Thoracoabdominal aortic aneurysm (TAAA) repair is associated with significant risks of blood loss and organ ischemia. This study evaluates the efficacy of a novel, modified Extracorporeal Circulation (mECC) circuit system designed to enhance blood conservation and selective organ perfusion during open TAAA repair.

Methods

In this retrospective analysis, 7 patients underwent open thoracoabdominal aortic repair between January 2022 and October 2024 using a modified extracorporeal circulation system. The system incorporated integrated roller pumps for selective visceral and renal perfusion, a centrifugal pump, and an integrated autotransfusion system reservoir to optimize hemodynamic control and minimize allogeneic blood transfusion. Demographic data, intraoperative parameters, transfusion requirements, and postoperative outcomes were assessed.

Results

The cohort consisted of 7 patients (57.1% male; mean age 54.4 ± 15.0 years). Crawford type I repair was performed in 71.4% of cases. The mean ECC duration was 104.4 ± 16.8 min, and mean aortic clamp time was 72.0 ± 18.5 min. The use of the integrated autotransfusion system resulted in reduced postoperative transfusion requirements and helped maintain hemoglobin levels. Postoperative complications included gastrointestinal events (42.9%), wound infections (42.9%), and spinal cord deficit (14.3%). Early in-hospital mortality was 14.3% (one patient, postoperative day 5). Kaplan-Meier analysis showed a 1-week survival rate of 85.7%, with all surviving patients remaining alive throughout the follow-up period.

Conclusion

The modified ECC system with integrated roller pumps and cell-saver technology demonstrated favorable short-term outcomes and effective blood conservation in open TAAA repair. This reservoirless, isothermic, centrifugal circuit with peripheral cannulation may offer a safe and efficient alternative for complex aortic surgery. Larger, prospective studies with extended follow-up are warranted to confirm these findings and evaluate long-term durability.

Keywords

thoracoabdominal aortic aneurysm blood conservation organ perfusion modified extracorporeal circulation aortic repair

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References

Ouzounian

LeMaire

Weldon

, et al. Open repair of thoracoabdominal aortic aneurysm: step-by-step. Operat Tech Thorac Cardiovasc Surg 2018; 23(1): 2–20. https://doi.org/10.1053/j.optechstcvs.2018.01.001

Coselli

LeMaire

Preventza

, et al. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg 2016; 151(5): 1323–1338. https://doi.org/10.1016/j.jtcvs.2015.12.050

Ballard

Duensing

. Extracorporeal techniques in thoracoabdominal aortic surgery. Semin Vasc Surg. 2000; 13(4): 331–339.

Mohebali

Carvalho

Lancaster

, et al. Use of extracorporeal bypass is associated with improved outcomes in open thoracic and thoracoabdominal aortic aneurysm repair. J Vasc Surg 2018; 68(4): 941–947. https://doi.org/10.1016/j.jvs.2017.12.072, Epub 2018 Mar 31.

Waked

Schepens

. State-of-the-art review on renal and visceral protection during open thoracoabdominal aortic aneurysm repair. J Vis Surg 2018; 4: 31. https://doi.org/10.21037/jovs.2018.01.01

Lopez-Marco

Adams

. Thoracoabdominal aneurysms—operative steps for Crawford extent II repair. Operat Tech Thorac Cardiovasc Surg 2022; 27(1): 39–64. https://doi.org/10.1053/j.optechstcvs.2021.12.001

Svensson

Crawford

Hess

, et al. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg 1993; 17(2): 357–368. https://doi.org/10.1016/0741-5214(93)90421-H

Pacini

Pantaleo

Di Marco

, et al. Visceral organ protection in aortic arch surgery: safety of moderate hypothermia. Eur J Cardio Thorac Surg 2014; 46(3): 438–443. https://doi.org/10.1093/ejcts/ezt665

Qing

Vazquez-Jimenez

Klosterhalfen

, et al. Influence of temperature during cardiopulmonary bypass on leukocyte activation, cytokine balance, and post-operative organ damage. Shock 2001; 15(5): 372–377. https://doi.org/10.1097/00024382-200115050-00002

10.

Todd

Warner

. A comfortable hypothesis reevaluated: cerebral metabolic depression and brain protection during ischemia. Anesthesiology 1992; 76(2): 161–164. https://doi.org/10.1097/00000542-199202000-00001

11.

Cina

Clase

. Coagulation disorders and blood product use in patients undergoing thoracoabdominal aortic aneurysm repair. Transfus Med Rev 2005; 19: 143–154. https://doi.org/10.1016/j.tmrv.2004.11.003

12.

Sikorski

Rizkalla

Yang

, et al. Autologous blood salvage in the era of patient blood management. Vox Sang 2017; 112: 499–510. https://doi.org/10.1111/vox.12527

13.

Kiser

Tanaka

Sandhu

, et al. Extensive cell salvage and postoperative outcomes following thoracoabdominal and descending aortic repair. J Thorac Cardiovasc Surg 2022; 163(3): 914. https://doi.org/10.1016/j.jtcvs.2020.06.005

14.

Ertugay

Apaydın

Karaca

, et al. Distal perfusion with modified centrifugal pump circuit in thoracic and thoracoabdominal aortic aneurysm repair. Vasc Endovasc Surg 2022; 56(8): 737–742. https://doi.org/10.1177/15385744221101345

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Modified Extracorporeal Circulation (mECC) for enhanced blood conservation in thoracoabdominal aortic surgery: A single-center experience