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

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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