Partial Cardiopulmonary Bypass in Thoracoabdominal aorta repair: A safe alternative in a low-volume center
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0248
Submission Type:
Abstract Submission
Authors:
Julian Senosiain (1), Jaime Camacho (2), Nicolas Nunez-Ordonez (1), Carlos Villa (3), TOMAS Chalela (4), Carlos Obando (5), NESTOR SANDOVAL (6), Andres Jimenez (7)
Institutions:
(1) N/A, N/A, (2) Fundación CardioInfantil, Bogota, NA, (3) Fundacion Cardioinfantil, Bogota, Colombia, (4) N/A, bogota, Colombia, (5) N/A, Bogota, Colombia, (6) FUNDACION CARDIOINFANTIL, BOGOTA, DC, (7) Fundacion Cardioinfantil / La Cardio - Universidad del Rosario, Bogota, DC
Submitting Author:
Julian Senosiain
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Co-Author(s):
Jaime Camacho
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Fundación CardioInfantil
Fundación CardioInfantil
Nicolas Nunez-Ordonez
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Carlos Villa
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Fundacion Cardioinfantil
Fundacion Cardioinfantil
TOMAS Chalela
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Carlos Obando
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NESTOR SANDOVAL
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FUNDACION CARDIOINFANTIL
FUNDACION CARDIOINFANTIL
Andres Jimenez
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Fundacion Cardioinfantil / La Cardio - Universidad del Rosario
Fundacion Cardioinfantil / La Cardio - Universidad del Rosario
Presenting Author:
Julian Senosiain
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Abstract:
Objective: To describe the experience in thoracoabdominal aorta (TAA) repair using partial cardiopulmonary bypass (CPB) at a cardiac surgery referral center.
Methods: This single-center retrospective study included all patients undergoing open TAA surgery from 2002 to November 2023. The extension of the repair was defined according to the Crawford classification, including an additional extension 0 for isolated descending aorta surgery. Open repairs were performed using selective visceral perfusion and sequential clamping aided by CPB supported by femoral arterial and venous cannulation. Postoperative in-hospital follow-up information was recorded. Variables were described according to their nature and distribution.
Results: A total of 124 patients were included with a median age of 58 years. Hypertension (72%) and Chronic lung disease (97%) were the most common comorbidities; 7% of patients had diabetes and 4% were on preoperative dialysis. Patients presented with NYHA class I-II in 92% of cases. Median EuroScore II was 4. Repair distribution was as follows: 37 extent 0, 18 extent I, 23 extent II, 21 Extent III and 24 extent IV. Most patients (59%) were intervened as elective cases. The main postoperative outcomes are summarized in Table 1.
Conclusions: Our results show comparable mortality to other centers that use left-heart bypass (LHB), with relatively low rates of stroke, spinal cord injury, gastrointestinal ischemic events, and renal replacement therapy. Therefore, despite the evidence favoring the use of LHB, partial CPB can still be an adequate alternative for TAA surgery in low-volume centers. Based on our experience, it allows for easier operative team coordination due to the use of standard CPB equipment in a setting where the learning curve for LHB use can be limited. This ensures a better intraoperative volume control with minimized blood loss thus guaranteeing a clean operative field and adequate organ perfusion.
Methods: This single-center retrospective study included all patients undergoing open TAA surgery from 2002 to November 2023. The extension of the repair was defined according to the Crawford classification, including an additional extension 0 for isolated descending aorta surgery. Open repairs were performed using selective visceral perfusion and sequential clamping aided by CPB supported by femoral arterial and venous cannulation. Postoperative in-hospital follow-up information was recorded. Variables were described according to their nature and distribution.
Results: A total of 124 patients were included with a median age of 58 years. Hypertension (72%) and Chronic lung disease (97%) were the most common comorbidities; 7% of patients had diabetes and 4% were on preoperative dialysis. Patients presented with NYHA class I-II in 92% of cases. Median EuroScore II was 4. Repair distribution was as follows: 37 extent 0, 18 extent I, 23 extent II, 21 Extent III and 24 extent IV. Most patients (59%) were intervened as elective cases. The main postoperative outcomes are summarized in Table 1.
Conclusions: Our results show comparable mortality to other centers that use left-heart bypass (LHB), with relatively low rates of stroke, spinal cord injury, gastrointestinal ischemic events, and renal replacement therapy. Therefore, despite the evidence favoring the use of LHB, partial CPB can still be an adequate alternative for TAA surgery in low-volume centers. Based on our experience, it allows for easier operative team coordination due to the use of standard CPB equipment in a setting where the learning curve for LHB use can be limited. This ensures a better intraoperative volume control with minimized blood loss thus guaranteeing a clean operative field and adequate organ perfusion.
Aortic Symposium:
Descending/Thoracoabdominal Aorta
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