Treatment of thoracoabdominal aortic aneurysm by prosthetic vessel replacement under left heart bypass.

Journal: Zhong Nan Da Xue Xue Bao. Yi Xue Ban = Journal Of Central South University. Medical Sciences
Treatment Used: Prosthetic Vessel Replacement under Left Heart Bypass
Number of Patients: 15
Published:
MediFind Summary

Summary: This study analyzed the effect of prosthetic vessel replacement (creating a way for the blood flow to reach its destination skipping the obstructed or destroyed vessel) under left heart bypass (redirects blood around a section of a blocked or partially blocked artery in the heart) in the treatment of thoracoabdominal aortic aneurysm (bulging and weakness in the wall of the aorta that extends from the chest into the abdomen; TAAA).

Conclusion: The effect of prosthetic vessel replacement (creating a way for the blood flow to reach its destination skipping the obstructed or destroyed vessel) under left heart bypass (redirects blood around a section of a blocked or partially blocked artery in the heart) in the treatment of thoracoabdominal aortic aneurysm (bulging and weakness in the wall of the aorta that extends from the chest into the abdomen) is good.

Abstract

Objective: Thoracoabdominal aortic aneurysm (TAAA) prosthetic vessel replacement is one of the most complex operations in the field of cardiovascular surgery. The key to success of this operation is to prevent and avoid ischemia of important organs while repairing TAAA. This study aims to summarize and analyze the effect of prosthetic vessel replacement under left heart bypass in the treatment of TAAA.

Methods: Data of 15 patients with TAAA who underwent prosthetic vessel replacement under left heart bypass in Xiangya Hospital of Central South University were retrospectively analyzed. According to Crawford classification, there were 2 cases of type I, 8 cases of type II, 3 cases of type III, and 2 cases of type V. There were 14 cases of selective operation and 1 case of emergency operation. All operations were performed under left heart bypass, and cerebrospinal fluid drainage was performed before operation. Left heart bypass was established by intubation of left inferior pulmonary vein and distal abdominal aorta or left femoral artery. The thoracoabdominal aorta was replaced segment by segment. After aortic dissection, the kidneys were perfused with cold crystalloid renal protective solution, and the celiac trunk and superior mesenteric artery were perfused with warm blood.

Results: One patient with TAAA after aortic dissection of type A died. During the operation, straight blood vessels were used to repair TAAA, and the celiac artery branches were trimmed into island shape and anastomosed with prosthetic vessels. After the operation, massive bleeding occurred at the anastomotic stoma, then anaphylactic reaction occurred during massive blood transfusion, resulting in death. One patient suffered from paraplegia due to ischemic injury of spinal cord. The other patients recovered well and were discharged. The postoperative ventilation time was (16.5±13.8) h and the postoperative hospital stay was (10±4) d. The amount of red blood cell transfusion was (13±9) U. The patients were followed up for 2 months to 2 years, and the recovery was satisfactory.

Conclusions: The effect of prosthetic vessel replacement under left heart bypass in the treatment of TAAA is good, which is worthy of clinical promotion.

Authors
Lingjin Huang, Wanjun Luo, Qinghua Hu, Chengliang Zhang, Xuliang Chen, Guoqiang Lin, Lian Duan, Zhi Ye, E Wang, Longyan Li

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