Abstract
The surgical correction of aneurysms in the descending thoracic aorta necessitates clamping the aorta both proximal and distal to the aneurysm. The affected length can vary from a few centimetres to large portions of the upper and lower descending aorta. Clamping times can vary from a few minutes to more than one hour. No matter which technique is applied, these operations are often accompanied by excessive blood loss and the need for rapid transfusion, resulting in substantial haemodynamic fluctuations. Hypothermia may become a problem in these patients because most blood warmers are unable to warm blood adequately (>35° C) at high flow rates (>100 cc/min). This may result in clotting problems. For this reason, our clinic decided from November 1990 to integrate a reservoir with its own heat exchanger (Cobe) into our left-left bypass system. This system largely regulates transfusion during partial extracorporeal circulation (PECC). The advantages of such a system are that (1) the transfusion rate can be adapted to blood loss and is not dependent on the quality and quantity of the infusion systems; (2) blood products and other infusion liquids are filtered; and (3) the transfusion blood is warmed. In this article, we describe our experience with this application of PECC on three patients who suffered excessive blood loss during operations for large thoracic aneurysms.
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