Surgical results for thoraco-abdominal aneurysm by modified DeBakey method using centrifugal biopump and renal cryopreservation.

BACKGROUND

In this paper, we report the surgical results of our DeBakey and Crawford combined method.

METHODS

From 1985 to 1995, 22 consecutive patients with thoraco-abdominal aneurysms underwent a modified DeBakey and Crawford combined procedure to minimize the ischemic time for the spinal cord and visceral organs. The extent of aneurysm as classified by Crawford was as follows: Group I, 12; Group II, 4, Group III, 3; Group IV, 3. The etiology of the aneurysm was atherosclerosis in 19, cystic medial necrosis in 2, and aortitis in 1. The aneurysm was approached through the spiral opening method. First, end-to-side distal anastomosis was performed above the bifurcation under partial aortic clamping, and this was followed by proximal anastomosis. During the end-to-end proximal anastomosis, a Gott shunt tube or heparinless left heart bypass was used. In two patients, left renal artery had been previously reconstructed by a saphenous vein graft extending from the left common iliac artery. Then aneurysm was opened, and the right renal artery and superiors mesenteric artery were perfused with cold blood. In two patients, partial cardiopulmonary bypass and selective perfusion were performed. In eight patients, renal artery, celiac artery, superior mesenteric artery, and intercostal artery were reconstructed with a branch graft.

RESULTS

No patient died within 30 days of surgery, however, one patient died of acute myocardial infarction (POD 54) and another of ventricular fibrillation during hemodialysis (POD 60). Postoperative complications included paraplegia, and renal failure requiring dialysis each in two patients. Postoperative angiography revealed 18/19 (94.7%) of grafts were patent.

CONCLUSIONS

In conclusion, by using different techniques for spinal cord and visceral protection, including the Gott shunt, Biomedicus pump, renal cryopreservation, and separate revascularization of viscera and intercostal arteries, good results could be obtained.