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Thoracic Aortic Surgery and Cardiopulmonary Bypass

  • Chapter
Cardiopulmonary Bypass

Abstract

Diseases of the aorta are common and most are surgically correctable.1–4 Aneurysmal disease alone is said to account for 1% to 2% of all deaths in industrialized countries.5 Unfortunately, no adequate medical therapy is currently available. It is not within the scope of this chapter to cover each of these diseases in detail. The goal is, however, to review the intraoperative surgical techniques used to approach the thoracic aorta, focusing on cardiopulmonary bypass (CPB) and its variations. The surgical, anesthetic, and bypass and perfusion techniques are dictated by the segment or segments of the aorta that need to be replaced or repaired (ie, ascending aorta, aortic arch, and/or descending/thoracoabdominal aorta; Figure 20.1). The institution and management of CPB will be reviewed for each type of aortic vascular disease.

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References

  1. Fradet G, Jamieson WRE, Janusz MT, et al. Aortic dissection: a six-year experience with 117 patients. Am J Surg 1988; 155: 697–670.

    Article  PubMed  CAS  Google Scholar 

  2. Svensson LG, Crawford ES, Hess KR, et al. Dissection of the aorta and dissection of aortic aneurysms: improving early and long-term surgical results. Circulation 1990; 82 (suppl IV): 24–38.

    Google Scholar 

  3. Stanson AW, Kazmier FJ, Hollier LH, et al. Penetrating atherosclerotic ulcers of the thoracic aorta: natural history and clinicopathologic correlations. Ann Vasc Surg 1986; 1: 15–23.

    PubMed  CAS  Google Scholar 

  4. Cohen M, Fuster V, Steele PM, et al. Coarctation of the aorta: long-term follow up and prediction of outcome after surgical correction. Circulation 1989; 80: 840–845.

    Article  PubMed  CAS  Google Scholar 

  5. Kuivaniemi H, Tromp G, Prockop DJ. Genetic causes of aortic aneurysms. J Clin Invest 1991; 88: 1441–1444.

    Article  PubMed  CAS  Google Scholar 

  6. McNamara JJ, Pressler JM. Natural history of arteriosclerotic thoracic aortic aneurysms. Ann Thorac Surg 1978; 25: 468–473.

    Article  Google Scholar 

  7. Martin TD, Accola KA. Megaaorta and aortoiliac obstruction: alternate method of cannulation. Ann Thorac Surg 1992; 53: 889–891.

    Article  PubMed  CAS  Google Scholar 

  8. Robicsek F. Apical aortic cannulation: application of an old method with new paraphernalia. Ann Thorac Surg 1991; 51: 330–332.

    Article  PubMed  CAS  Google Scholar 

  9. Crawford ES, Crawford JL, Safi HJ, et al. Redo operations for recurrent aneurysmal disease of the ascending aorta and transverse aortic arch. Ann Thorac Surg 1985; 40: 439–455.

    Article  PubMed  CAS  Google Scholar 

  10. Rosenbloom M, Muskett AD. Simplified method for femoral venous cannulation. Ann Thorac Surg 1991; 51: 846–847.

    Article  PubMed  CAS  Google Scholar 

  11. Martin TD, Craver JM, Gott JP, et al. A prospective randomized trial of retrograde warm blood cardioplegia: myocardial benefit and neurologic threat. Ann Thorac Surg 1994; 57: 288–304.

    Article  Google Scholar 

  12. Lichtenstein SV, Able JG, Salerno TA. Warm heart surgery and results of operation for recent myocardial infarction. Ann Thorac Surg 1991; 52: 455–460.

    Article  PubMed  CAS  Google Scholar 

  13. Crawford ES, Coselli JS, Safi HJ. Partial cardiopulmonary bypass, hypothermic circulatory arrest, and posterolateral exposure for thoracic aortic aneurysm operations. J Thorac Cardiovasc Surg 1987; 94: 824–827.

    PubMed  CAS  Google Scholar 

  14. Massimo Carlo G, Presenti LF, Marranci P, et al. Extended and total aortic resection in the surgical treatment of acute type A aortic dissection: experience with 54 patients. Ann Thorac Surg 1988; 46: 420–424.

    Article  Google Scholar 

  15. Wareing TH, Davila-Roman VG, Barzilai B, et al. Management of the severely atherosclerotic ascending aorta during cardiac operations. J Thorac Cardiovasc Surg 1992; 103: 453–462.

    PubMed  CAS  Google Scholar 

  16. DeBakey ME, Lawrie GM, Crawford ES, et al. Surgical treatment of dissecting aortic aneurysms: 28 years experience with 527 cases. Contemp Surg 1984; 9: 25.

    Google Scholar 

  17. Caramutti VM, Dantur JR, Favaloro MR, et al. Deep hypothermia and circulatory arrest as an elective technique in the treatment of type B dissection aneurysm of the aorta. J Card Surg 1989; 4: 206–215.

    Article  PubMed  CAS  Google Scholar 

  18. Bachet J, Teodori G, Goudot B, et al. Replacement of the transverse aortic arch during emergency operations for type A acute aortic dissection. J Thorac Cardiovasc Surg 1988; 96: 878–886.

    PubMed  CAS  Google Scholar 

  19. Graham JM, Stinnett DM. Operative management of acute aortic dissection using profound hypothermia and circulatory arrest. Ann Thorac Surg 1987; 44: 192–198.

    Article  PubMed  CAS  Google Scholar 

  20. Crawford ES, Svensson LG, Coselli JS, et al. Surgical treatment of aneurysm and/or dissection of the ascending aorta transverse aortic arch. J Thorac Cardiovasc Surg 1989; 98: 659–674.

    PubMed  CAS  Google Scholar 

  21. Greeley WJ, Kern FH, Meliones JN, et al. Effect of deep hypothermia and circulatory arrest on cerebral blood flow and metabolism. Ann Thorac Surg 1993; 56: 1464–1466.

    Article  PubMed  CAS  Google Scholar 

  22. Almond CH, Jones JC, Snyder HM, et al. Cooling gradients and brain damage with deep hypothermia. J Thorac Cardiovasc Surg 1964; 48: 890–897.

    PubMed  CAS  Google Scholar 

  23. Griepp RB, Ergin MA, Lansman SL, et al. The physiology of hypothermic circulatory arrest. Semin Thorac Cardiovasc Surg 1991; 3: 188–193.

    PubMed  CAS  Google Scholar 

  24. Hollier LH. Protecting the brain and spinal cord. J Vasc Surg 1987; 5: 524–528.

    PubMed  CAS  Google Scholar 

  25. Vanderlinden J, Astudillo R, Ekroth R, et al. Cerebral lactate release after circulatory arrest but not after low flow in pediatric heart operations. Ann Thorac Surg 1993; 56: 1485–1489.

    Google Scholar 

  26. Mohri H, Sadahiro M, Akimoto H, et al. Protection of the brain during hypothermic perfusion. Ann Thorac Surg 1993; 56: 1493–1496.

    Article  PubMed  CAS  Google Scholar 

  27. Williams MD, Rainer G, Fieger HG, et al. Cardiopulmonary bypass, profound hypothermia and circulatory arrest for neurosurgery. Ann Thorac Surg 1991; 52: 1069–1075.

    Article  PubMed  CAS  Google Scholar 

  28. Woodhall B, Sealy WC, Hall KD, et al. Craniotomy under conditions of guinidine protected cardioplegia and profound hypothermia. Ann Surg 1960; 152: 37–44.

    Article  PubMed  CAS  Google Scholar 

  29. Coselli JS, Crawford ES, Beall AC Jr, et al. Determination of brain temperatures for safe circulatory arrest during cardiovascular operations. Ann Thorac Surg 1988; 45: 638–642.

    Article  PubMed  CAS  Google Scholar 

  30. Murkin JM. Anesthesia, the brain and cardiopulmonary bypass. Ann Thorac Surg 1993; 56: 1461–1463.

    Article  PubMed  CAS  Google Scholar 

  31. Nussmeier NA, Arlund C, Slogoff S. Neuropsychiatric complications after cardiopulmonary bypass: cerebral protection by a barbiturate. Anesthesiology 1986; 64: 165–170.

    Article  PubMed  CAS  Google Scholar 

  32. Zaidan JR, Klochany A, Martin W, et al. Effect of thiopental on neurologic outcome following coronary artery bypass grafting. Anesthesiology 1991; 74: 406–411.

    Article  PubMed  CAS  Google Scholar 

  33. Woodcock TE, Murkin JM, Farrar JK, et al. Pharmacologic EEG suppression during cardiopulmonary bypass: cerebral hemodynamic and metabolic effects of thiopental or isoflurane during hypothermia and normothermia. Anesthesiology 1987; 67: 218–224.

    Article  PubMed  CAS  Google Scholar 

  34. Forsman M, Olsnes BT, Semb G, et al. Effects of nimodipine on cerebral blood flow and neuropsychological outcome after cardiac surgery. Br J Anesth 1990; 65: 514–520.

    Article  CAS  Google Scholar 

  35. Reeves RB. An imidazate alpha state hypothesis for vertebrate acid-base regulation: tissue carbon dioxide content and body temperature in bullfrogs. Respir Physiol 1972; 14: 219–236.

    Article  PubMed  CAS  Google Scholar 

  36. Dickinson DF, Sambrooks JE. Intellectual performance in children after circulatory arrest with profound hypothermia in infancy. Arch Dis Child 1979; 54: 1–6.

    Article  PubMed  CAS  Google Scholar 

  37. Charleson PM, MacArthur BA, Barret-Boyes BG, et al. Developmental progress after cardiac surgery in infancy using hypothermia and circulatory arrest. Circulation 1980; 62: 855–861.

    Google Scholar 

  38. Messmer BJ, Schallberger U, Garriker R, et al. Psychomotor and intellectual development after deep hypothermia and circulatory arrest in early infancy. J Thorac Cardiovasc Surg 1976; 72: 495–502.

    PubMed  CAS  Google Scholar 

  39. Veda Y, Miki S, Husuhara K, et al. Surgical treatment of aneurysm of dissection involving the ascending aorta and aortic arch, utilizing circulatory arrest and retrograde cerebral perfusion. J Cardiovasc Surg 1990; 31: 553–558.

    Google Scholar 

  40. Usui A, Hotta T, Hiroura M, et al. Retrograde cerebral perfusion through a superior vena cavai cannula protects the brain. Ann Thorac Surg 1992; 53: 47–53.

    Article  PubMed  CAS  Google Scholar 

  41. Usui A, Oohara K, Liu T, et al. Determination of optimum retrograde cerebral perfusion conditions. J Thorac Cardiovasc Surg 1994; 107: 300–308.

    PubMed  CAS  Google Scholar 

  42. Mori A. Retrograde cerebral perfusion using pulsatile flow under conditions of profound hypothermia. Ann Thorac Surg 1993; 56: 1497–1498.

    Article  PubMed  CAS  Google Scholar 

  43. Valk A, Kanten RA, Oosterheert M. Treating massive air embolism. J Extracorp Technol 1982; 14: 325–327.

    Google Scholar 

  44. DeBakey ME, Beall AC, Cooley DA, et al. Resection and graft replacement of aneurysms involving the transverse arch of the aorta. Surg Clin North Am 1966; 46: 1057–1071.

    CAS  Google Scholar 

  45. Bloodwell RD, Hallman GL, Cooley DA. Total replacement of the aortic arch and the “subclavian steal” phenomenon. Ann Thorac Surg 1968; 5: 236–245.

    Article  PubMed  CAS  Google Scholar 

  46. Pearce CW, Weichert RF III, del Real RE. Aneurysms of the aortic arch. Simplified technique for excision and prosthetic replacement. J Thorac Cardiovasc Surg 1969; 58: 886–890.

    PubMed  CAS  Google Scholar 

  47. Crawford ES, Saleh SA, Schuessler JS. Treatment of aneurysms of the transverse aortic arch. J Thorac Cardiovasc Surg 1979; 78: 383–393.

    PubMed  CAS  Google Scholar 

  48. Cooley DA, Oh DA, Frazier OH, et al. Surgical treatment of aneurysms of the transverse aortic arch: experience with 25 patients using hypothermic technique. Ann Thorac Surg 1981; 32: 260–272.

    Article  PubMed  CAS  Google Scholar 

  49. Stoney WS, Alford WC, Burrus GR, et al. Air embolism and other accidents using pump oxygenators. Ann Thorac Surg 1980; 29: 336–340.

    Article  PubMed  CAS  Google Scholar 

  50. Yamashita C, Nakamura H, Nishikawa Y, et al. Retrograde cerebral perfusion with circulatory arrest in aortic arch aneurysms. Ann Thorac Surg 1992; 54: 566–568.

    Article  PubMed  CAS  Google Scholar 

  51. Safi HJ, Brien HW, Winter JN, et al. Brain protection via cerebral retrograde perfusion during aortic arch aneurysm repair. Ann Thorac Surg 1993; 56: 270–276.

    Article  PubMed  CAS  Google Scholar 

  52. DeBakey ME, Cooley DA, Crawford ES, et al. Successful resection of fusiform aneurysm of the aortic arch with replacement by homograft. Surgery 1957; 105: 657–664.

    CAS  Google Scholar 

  53. DeBakey ME, Cooley DA, Crawford ES, et al. Aneurysms of the thoracic aorta. J Thorac Surg 1953; 36: 393–420.

    Google Scholar 

  54. Muller WH, Warren WD, Blanton FS Jr. A method for resection of aortic arch aneurysms. Ann Surg 1960; 151: 225–230.

    Article  PubMed  Google Scholar 

  55. Bjork VO. Successful replacement of the total aortic arch for aneurysm. J Thorac Cardiovasc Surg 1963; 45: 817–823.

    PubMed  CAS  Google Scholar 

  56. Dubost CH, Blondeau PH, Piunica A, et al. Treatment chirurgical des aneurysms de l’aorte thoracique à propos de 25 cas explores chirurgicalement. J Chir 1962; 83: 331–359.

    CAS  Google Scholar 

  57. First WH, Baldwin JC, Vaughn AS, et al. A reconsideration of cerebral perfusion in aortic arch replacement. Ann Thorac Surg 1986; 42: 273–281.

    Article  Google Scholar 

  58. Kazui T, Inoue N, Yama O, et al. Selective cerebral perfusion during operation for aneurysms of the aortic arch: a reassessment. Ann Thorac Surg 1992; 53: 109–114.

    Article  PubMed  CAS  Google Scholar 

  59. Tabayashi K, Niibori K, Iguchi A, et al. Replacement of the transverse aortic arch for type A acute aortic dissection. Ann Thorac Surg 1993; 55: 864–867.

    Article  PubMed  CAS  Google Scholar 

  60. Symbas PN, Pfaender LM, Drucker MH, et al. Cross-clamping of the descending aorta: hemodynamic and neurohumoral effects. J Thorac Cardiovasc Surg 1983; 85: 300–305.

    PubMed  CAS  Google Scholar 

  61. Saleh SA. Anesthesia and monitoring for aortic aneurysm surgery. World J Surg 1980; 4: 689–692.

    Article  PubMed  CAS  Google Scholar 

  62. Spargo P, Crosse MM. Anesthetic problems in cross clamping of the aorta. Ann R Coll Surg Eng 1988; 70: 64–68.

    CAS  Google Scholar 

  63. Svensson LG, Crawford ES, Hess KR, et al. Thoracoabdominal aortic aneurysms associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 27 patients. J Vasc Surg 1992; 16: 378–389.

    Article  PubMed  CAS  Google Scholar 

  64. Schepens MA, Defauw JJ, Hamerlijnck RP, et al. Surgical treatment of thoracoabdominal aortic aneurysms by simple cross clamping: risk factors and late results. J Thorac Cardiovasc Surg 1994; 107: 134–142.

    PubMed  CAS  Google Scholar 

  65. Borst HG, Jurmann M, Buhner B, et al. Risk of replacement of descending aorta with a standardized left heart bypass technique. J Thorac Cardiovasc Surg 1994; 107: 125–133.

    Google Scholar 

  66. VonSegesser LK, Kilher I, Jenni R, et al. Improved distal circulatory support for repair of descending thoracic aortic aneurysms. Ann Thorac Surg 1993; 56: 1373–1380.

    Article  Google Scholar 

  67. Svensson LG, Coselli JS, Safi HJ, et al. Appraisal of adjuncts to prevent acute renal failure after surgery on the thoracic or thoracoabdominal aorta. J Vasc Surg 1989; 10: 230–239.

    PubMed  CAS  Google Scholar 

  68. Carlson DE, Karp RB, Kouchoukos NT. Surgical treatment of aneurysms of the descending thoracic aorta: an analysis of 85 patients. Ann Thorac Surg 1983; 35: 58–69.

    Article  PubMed  CAS  Google Scholar 

  69. Najafi H. 1993 Update: descending aortic aneurysmectomy without adjuncts to avoid ischemia. Ann Thorac Surg 1993; 55: 1042–1045.

    Article  Google Scholar 

  70. Crawford ES, Mizrahi EM, Hess KR, et al. The impact of distal aortic perfusion and somatosensory evoked potential monitoring on prevention of paraplegia after aortic aneurysm operation. J Thorac Cardiovasc Surg 1988; 95: 357–367.

    PubMed  CAS  Google Scholar 

  71. deMol B, Hamerlijnck RP, Boezeman E, et al. Prevention of spinal cord ischemia in surgery of thoracoabdominal aneurysms: the biomedicus pump, the recording of somatosensory evoked potentials and the impact on surgical strategy. Eur J Cardiothorac Surg 1990; 4: 658–664.

    Article  CAS  Google Scholar 

  72. Walls JT, Curtis JJ, Boley T. Sarns centrifugal pump for repair of thoracic aortic injury: case reports. J Trauma 1989; 29: 1283–1285.

    Article  PubMed  CAS  Google Scholar 

  73. Gott VL, Whippen JD, Dutton RC. Heparin bonding on colloidal graphite surfaces. Science 1963; 142: 1297–1298.

    Article  PubMed  CAS  Google Scholar 

  74. Verdant A, Page A, Cossette R, et al. Surgery of the descending thoracic aorta. Spinal cord protection with the Gott Shunt. Ann Thorac Surg 1988; 46: 147–154.

    Article  PubMed  CAS  Google Scholar 

  75. Murray GF, Young WG. Thoracic aneurysmectomy utilizing direct left ventriculo femoral shunt (TDMAC-heparin) bypass. Ann Thorac Surg 1976; 21: 26–29.

    Article  PubMed  CAS  Google Scholar 

  76. Acher CW, Wynn MM, Archibald J. Naloxene and spinal fluid drainage as adjuncts in the surgical treatment of thoracoabdominal and thoracic aneurysms. Surgery 1990; 108: 755–762.

    PubMed  CAS  Google Scholar 

  77. Wisselink W, Becker MD, Nguyen JH, et al. Protecting the ischemic spinal cord during aortic clamping: the influence of selective hypothermia and spinal cord perfusion pressure. J Vasc Surg 1994; 19: 788–795.

    PubMed  CAS  Google Scholar 

  78. Kouchoukos NT, Wareing TH, Izumoto H, et al. Elective hypothermia and cardiopulmonary bypass and circulatory arrest for spinal cord protection during operations on the thoracoabdominal aorta. J Thorac Cardiovasc Surg 1990; 99: 659–664.

    PubMed  CAS  Google Scholar 

  79. Dumanian AV, Hoeksema TD, Santschi DR, et al. Profound hypothermia and circulatory arrest in the surgical treatment of traumatic aneurysm of the thoracic aorta. J Thorac Cardiovasc Surg 1970; 59: 541–545.

    PubMed  CAS  Google Scholar 

  80. Berguer R, Porto J, Fedoronko B, et al. Selective deep hypothermia of the spinal cord prevents paraplegia after aortic cross clamping in the dog model. J Vasc Surg 1992; 15: 62–72.

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. Tomas D. Martin
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Editors and Affiliations

  1. Department of Anesthesiology, Emory University School of Medicine, 30322, Atlanta, GA, USA

    Christina T. Mora M.D.

  2. Division of Cardiothoracic Surgery, Emory University School of Medicine, 30322, Atlanta, GA, USA

    Robert A. Guyton M.D.

  3. Perfusion Services, Emory University Hospitals, 30322, Atlanta, GA, USA

    Richard L. Rigatti B.S., C.T., C.C.T.

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© 1995 Springer-Verlag New York Inc.

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Martin, T.D. (1995). Thoracic Aortic Surgery and Cardiopulmonary Bypass. In: Mora, C.T., Guyton, R.A., Finlayson, D.C., Rigatti, R.L. (eds) Cardiopulmonary Bypass. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-2484-6_20

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  • DOI: https://doi.org/10.1007/978-1-4612-2484-6_20

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7557-2

  • Online ISBN: 978-1-4612-2484-6

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