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.