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The Annals of Thoracic Surgery, Vol 56, 1373-1380, Copyright © 1993 by The Society of Thoracic Surgeons
LK von Segesser, I Killer, R Jenni, U Lutz and MI Turina
Bleeding is a well-known problem when cardiopulmonary bypass with full
systemic heparinization is used for distal support during aortic cross-
clamping. The recent advent of heparin-coated cardiopulmonary bypass
equipment prompted our review of 91 consecutive patients who underwent
repair of descending thoracic and thoracoabdominal aortic aneurysms. Two
different surgical techniques were used: 42 of 91 patients had simple
aortic cross-clamping and rapid reanastomosis, whereas 49 of 91 had distal
support using all heparin-coated perfusion equipment with low systemic
heparinization (100 IU/kg body weight; activated coagulation time > 180
seconds). Baseline parameters, location (thoracoabdominal: 28/91; 31%), and
type of aneurysm (ruptured: 14/91; 15%) were similar in both groups.
Cross-clamp time was 37 +/- 22 minutes for support versus 29 +/- 13 minutes
for simple clamping (p < 0.05). There were fewer revisions due to
bleeding for support (1/49 patients; 2%) versus simple (4/42; 10%; p <
0.05) and fewer patients with impaired renal function requiring temporary
hemofiltration for support (4/49 patients; 8%) versus simple (6/42; 14%).
Hospital mortality was lower for support (5/49; 10%) versus simple (8/42;
19%). Transfusion requirements during operation were 3,732 +/- 3,458 mL for
simple versus 3,392 +/- 2,058 mL for support (not significant). Chest tube
drainage totaled 982 +/- 1,102 mL for simple versus 720 +/- 618 mL for
support (not significant). The total volume requirements were 8,156 +/-
4,753 mL for simple versus 7,495 +/- 3,342 mL for support (not significant)
during operation and 4,416 +/- 2,422 mL for simple versus 3,380 +/- 1,432
mL for support (p < 0.025) during the 24 hours after operation.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Improved distal circulatory support for repair of descending thoracic aortic aneurysms
Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
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