Normothermic artery bypass and visceral-anastomosis-first strategy in thoracoabdominal aortic aneurysm repair

P0227 

Abstract Submission 

Shuai Zhang (1), Jing Sun (2)

(1) Department of Cardiovascular Surgery, Fuwai Hospital, CAMS&PUMC, Beijing, Beijing, (2) Department of Cardiovascular Surgery, Fuwai Hospital, Beijing, Beijing

Shuai Zhang    -  Contact Me
Department of Cardiovascular Surgery, Fuwai Hospital, CAMS&PUMC

Jing Sun    -  Contact Me
Department of Cardiovascular Surgery, Fuwai Hospital

Shuai Zhang    -  Contact Me
Department of Cardiovascular Surgery, Fuwai Hospital, CAMS&PUMC

Objective: To demonstrates that the implementation of our normothermic artery bypass and visceral-anastomosis-first strategy in the repair of thoracoabdominal aortic aneurysm represents a safe and reproducible treatment approach, which offers improved protection for visceral organs and the spinal cord, reduced reliance on blood products, and favorable clinical outcomes in terms of mortality, complications such as paraplegia and continuous renal replacement therapy (CRRT), as well as lower lactate levels.
Methods: From July 2019 to February 2022, a total of 26 patients with thoracoabdominal aortic aneurysm (18 males and 8 females) underwent the normothermic artery bypass and visceral-anastomosis-first strategy for TAAA repair at our institution. The surgical procedure involved a combined left thoracoabdominal incision. Initially, access to the artificial vessel was established through one of the four branches, providing entry into the proximal aorta. Subsequently, anastomoses were sequentially performed for the abdominal trunk, superior mesenteric artery, renal artery, and intercostal artery. Finally, the proximal and distal anastomoses were completed to ensure effective blood supply to the distal branches. This approach was designed to optimize normothermic iliac perfusion, with the primary objective of safeguarding the viscera and spinal cord, while minimizing blood damage and coagulation disorders.
Results: The mean age of the patients was 38.9±12.8 years (range,15.0-58.0 years), with 18 patients(69.2%)being female. The most common presentation was Crawford type II aneurysms, observed in 46.2% of patients. The procedure was successfully performed in all 26 patients. The mean operative time was 551.4±106.2 minutes. Typically, patients' lactate levels returned to normal within approximately 48 hours postoperatively. Prior to discharge, average creatinine levels were within the normal range. Only one patient required re-exploration due to bleeding; otherwise, there were no cases of postoperative paraplegia. The patients were discharged from the hospital with a median length of stay of 17.0 days. The mean follow-up time was 23.5±9.3 months, with a follow-up rate of 100%. No late deaths occurred, and none of the patients required further surgery for aortic valve or other aortic diseases.
Conclusions: Open surgical repair of thoracoabdominal aortic aneurysm remains a crucial therapeutic approach and continues to be challenging. The available data indicate that our normothermic artery bypass and visceral-anastomosis-first strategy represents a secure and replicable method, particularly when executed at an experienced center, can produce remarkable outcomes.

Descending/Thoracoabdominal Aorta