Moderate hypothermia, with partial bypass and segmental sequential repair for thoracoabdominal aortic aneurysm Steven M. Frank, MD, Stephen D. Parker,

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Presentation transcript:

Moderate hypothermia, with partial bypass and segmental sequential repair for thoracoabdominal aortic aneurysm Steven M. Frank, MD, Stephen D. Parker, MD, Peter Rock, MD, Randolph B. Gorman, MD, Susan Kelly, RN, Charles Beattie, MD, PhD, G.Melville Williams, MD Journal of Vascular Surgery Volume 19, Issue 4, Pages 687-697 (April 1994) DOI: 10.1016/S0741-5214(94)70043-5 Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Stage 1; completion of proximal anastomosis between graft and descending thoracic aorta just distal to origin of left subclavian artery. Left atrial to left common femoral bypass sustains perfusion of lower body. It also provides for rapid cooling to temperature of 30° C. Journal of Vascular Surgery 1994 19, 687-697DOI: (10.1016/S0741-5214(94)70043-5) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Stage 2; aorta, including two pairs of significant intercostal arteries, is being sutured for appropriately sized ellipse cut from graft. Spinal cord is likely to be ischemic during this interval. Journal of Vascular Surgery 1994 19, 687-697DOI: (10.1016/S0741-5214(94)70043-5) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Stage 3; large elliptical portion of aorta containing orifices of celiac axis, superior mesenteric and right renal arteries is shown being attached to oval defect cut from graft. Intercostal arteries are reperfused while kidneys and viscera are ischemic. At this stage rewarming is begun through femoral cannula. Journal of Vascular Surgery 1994 19, 687-697DOI: (10.1016/S0741-5214(94)70043-5) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Stage 4; distal anastomosis is shown being completed. Left renal artery has been attached to graft using short segment of PTFE. Atrial femoral bypass is activated intermittently simply to prevent clotting. After completion of this anastomosis, high flow atrial-femoral bypass is reinstituted to achieve normothermia. During this period of time, surgical hemostasis is achieved and decannulation carried out after 15 to 20 minutes of rewarming. Journal of Vascular Surgery 1994 19, 687-697DOI: (10.1016/S0741-5214(94)70043-5) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Upper (tympanic) and lower (urinary bladder) core temperatures are shown at 5-minute intervals. Top panel (A) is from patient undergoing aortic valve replacement with full cardiopulmonary bypass from right atrium to ascending aorta. In this setting tympanic temperature responds more rapidly to changes in perfusion temperature. Bottom panel (B) is from patient undergoing thoracoabdominal aneurysm surgery with partial bypass from left atrium to left femoral artery. Response to cooling and rewarming is reversed in this setting, most likely from direct effects of perfusion temperature in femoral and pelvic vessels. Journal of Vascular Surgery 1994 19, 687-697DOI: (10.1016/S0741-5214(94)70043-5) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Posterior tibial nerve somatosensory evoked cortical potentials at baseline (36° C) and hypothermic (30° C) temperatures demonstrating a 16% increase in latency with hypothermia but little change in amplitude. Journal of Vascular Surgery 1994 19, 687-697DOI: (10.1016/S0741-5214(94)70043-5) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions