Perfusion with low systemic heparinization during resection of descending thoracic aortic aneurysms

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Abstract
Two series of 20 consecutive patients with aneurysms of the descendingthoracic aorta (TAA) and thoraco-abdominal aorta (TAAA) underwentmultisegmental aortic repair using either simple normothermic crossclampingand rapid reanastomosis (historic) or partial cardiopulmonary bypass (CPB)with heparin coated perfusion equipment and low systemic heparinization(actual). Chronic lesions were present in 14/20 patients (70%) for simpleversus 13/20 (65%) for CPB (NS). Acute lesions (symptomatic less than 24 h)were present in 6/20 patients (30%) for simple versus 7/20 (35%) for CPB(NS). Dissecting lesions were observed in 4/20 patients (20%) for simpleversus 8/20 (40%) for CPB (NS). Aneurysmal lesions were found in 16/20patients (80%) for simple versus 12/20 (60%) for CPB (NS). Mean number ofaortic segments (n = 8) resected was 3.2 +/- 1.1 for simple versus 4.0 +/-1.2 for CPB (P less than 0.01). Replacement of the transdiaphragmatic aortawas performed in 10/20 patients (50%) for simple and 13/20 patients (65%)for CPB (NS). A heparin loading dose of 5000 IU for simple versus 100 IU/kgbodyweight for CPB was used. In the latter group, the activated clottingtime was kept above 180 s during a mean perfusion time of 46 +/- 28 min ata mean pump flow of 2.2 +/- 0.7 l/min. Thirty- day survival for all(transdiaphragmatic) was 12/20 (5/10) patients for simple versus 20/20(13/13) for CPB (P less than 0.002, P less than 0.01). One-year survival(all) was 11/20 patients (55%) for simple versus 19/20 (95%) for CPB (Pless than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

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