Partial left heart bypass with centrifugal pump and limited anticoagulation during the resection of coarctation of the aorta

Abstract

Resection of coarctation of the aorta necessitates crossclamping of the descending aorta. Despite the existence of a collateral circulation, spinal cord ischaemia and intestinal ischaemia may occur associated with a prolonged crossclamp time and distal hypoperfusion during the operation. To prevent these severe complications and to control hypertension proximal to the clamp, circulatory support may be necessary.

We performed partial left heart bypass (PLHB) with limited anticoagulation in four patients, using a centrifugal pump in orderto sustain a mean arterial blood pressure of at least 60mmHg in the distal thoracic aorta below the clamped coarctated segment. The method is practical, simple and safe. It combines features of several methods of protection of the spinal cord: adequate distal perfusion of the aorta at a desired flow rate and blood pressure, avoidance of proximal hypertension, minimal aortic and cardiac manipulation and avoidance of bleeding tendency by limited heparinization. Vasodilating drugs with their adverse effect on distal aortic pressure are not necessary in this situation.

Postoperatively, neurological sequelae orvital organ damage did not occur in our patients.

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References

Moreno NN , de Campo T. , Kaiser GA , Pallares VS Technical and pharmacological management of distal hypotension during the repair of coarctation of the aorta. J Cardiovasc Surg 1980; 80: 182-86.

Connolly JE , Kountz SL , Boyd RJ Left heart bypass: experimental and clinical observations on its regulation with particular reference to maintenance of maximal renal blood flow. J Thorac Cardiovasc Surg 1962; 44: 577.

Krieger KH , Spencer FC Is paraplegia after repair of coarctation of the aorta due principally to distal hypotension during aortic cross clamping? Surgery 1985; 97: 2.

Wadouh F. , Arndt C. , Oppermann E. , Borst HG , Wadouh R. The mechanism of spinal cord injury after simple and double aortic cross-clamping . J Thorac Cardiovasc Surg 1986; 92: 121-27.

Sellors TH , Hobslkey M. Coarctation of the aorta. Effect of operation on blood pressure. Lancet 1963; i: 1387-91.

Connors JP , Ferguson TB , Roper CL , Weldon CS The use of the TDMAC-heparin shunt in replacement of the descending thoracic aorta. Ann Surg 1975; 181: 735.

Murray GF , Young WG Jr. Thoracic aneurysmectomy utilizing direct left ventriculo-femoral shunt (TDAMC-Heparin) bypass. Ann Thorac Surg 1976; 21: 26.

Lam CR , Arciniegas E. Surgical management of coarctation of the aorta with minimal collateral circulation . Ann Surg 1973; 178: 693.

Hughes RK , Reemtsma K. Correction of coarctation of the aorta. Manometric determinations of safety during test occlusion. J Thorac Cardiovasc Surg 1971; 62: 31.

10.

Dixon CM , Magovern GJ Evaluation of the Biopump for long-term cardiac support without heparinisation . J Extra Corpor Techn 1982; 14: 331.

11.

Brewer LA Repair of coarctation of the aorta. A constant neurological challenge. Thirty-third Congress of the European Society for Cardiovascular Surgery, Madrid, Spain, Sept: 1984.

12.

Brewer LA , Fosburg RG , Mulder GA , Verska JJ Spinal cord complications following surgery for coarctation of the aorta. J Thorac Cardiovasc Surg 1972; 64: 368.

13.

Livesay J. , Cooley DA , Ventemiglia RA et al. Surgical experience in descending thoracic aneurysmectomy with and without adjuncts to avoid ischaemia. Ann Thorac Surg 1985; 39: 37-46.

14.

Krause A. , Ferguson TB , Weldon CS Thoracic aneurysmectomy utilizing the TDMAC-heparin shunt. Ann Thorac Surg 1972; 14: 123.

15.

Molina JE , Cogordan J. , Einzig S. et al. Adequacy of ascending aorta-descending aorta shunt during cross clamping of the thoracic aorta for prevention of spinal cord injury. J Thorac Cardiovasc Surg 1985; 90: 126.

16.

Lawrence GH , Hessel EA , Sauvage LR , Krause AH Results of the use of TDAMC-heparin shunt in the surgery of aneurysms of the descending thoracic aorta. J Thorac Cardiovasc Surg 1977; 73: 393.

17.

Watterson KG , Dhasmana JP , O'Higgins JW, Wisheart JD. Distal aortic pressure during coarctation operation. Ann Thorac Surg 1990; 49: 987-90.