P248. Partial Cardiopulmonary Bypass in Thoracoabdominal aorta repair: A safe alternative in a low-volume center
Fundacion Cardioinfantil
Bogota DC
Colombia - Contact Me
I am a recent graduate specializing in cardiac surgery with a strong passion for innovative and endovascular procedures, particularly in the fields of complex arch and thoracoabdominal aortic surgery. Throughout my fellowship, I have diligently honed my medical and surgical skills, while also gaining invaluable experience working collaboratively within a team environment. This comprehensive training has equipped me to provide patients with the highest standard of care, delivered with both expertise and compassion.
Having served as the principal surgeon in over 100 surgeries, including procedures such as coronary artery bypass grafting, aortic and mitral valve replacement, Bentall operations, descending thoracic aorta replacement, and hemiarch surgeries, I have successfully managed a diverse range of cases. Additionally, I have had the privilege of assisting in over 1200 surgeries, notably contributing to complex procedures like aortic arch replacement, thoracoabdominal aortic replacement, Ross and David procedures.
My extensive experience as both a principal surgeon and an assisting physician has nurtured my ability to handle intricate surgical techniques with precision and care. I am committed to staying at the forefront of advancements in cardiac surgery, ensuring that my patients in Colombia receive the most effective and innovative treatments available.
By combining my exceptional technical skills with a compassionate approach, I strive to provide patients with not only exceptional medical outcomes but also a sense of comfort and understanding during their journey towards recovery.
Description
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.
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