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Ann Thorac Surg 1997;64:286-287
© 1997 The Society of Thoracic Surgeons

Correspondence

Controlled Limb Reperfusion in Patients Having Cardiac Operations

Christian Schlensak, MD, Koppany Sarai, MD, Friedhelm Beyersdorf, MD

Department of Cardiovascular Surgery, University of Freiburg, Hugstetter Str 55, D-79106 Freiburg, Germany.

To the Editor:

We read with interest the article by Greason and associates [1], who described a method of providing distal limb perfusion during prolonged cardiopulmonary support. Unfortunately, the technique has been used clinically in only 2 patients and results are limited.

We agree that severe limb ischemia in patients having cardiac operations may occur after prolonged femoral vessel cannulation, percutaneous cardiopulmonary bypass, intraaortic balloon pump insertion, dissecting aneurysms, or emboli. Uncontrolled blood reperfusion after conventional surgical therapy can cause a postischemic syndrome with multiple local and systemic complications.

To prevent reperfusion damage we recommend our strategy of controlled limb reperfusion, which was successfully performed in 19 patients with severe prolonged unilateral or bilateral ischemia in different cardiac surgery centers (Berlin, Frankfurt, Freiburg, and Mainz). The mean ischemic period in these 19 patients was 26 ± 6 hours [2].

After conventional thrombectomy from the iliac and femoral arteries a 22F cannula was inserted into the iliac artery to aspirate autogenous oxygenated blood for subsequent admixture with the reperfusion solution. A single roller pump permitted delivery of oxygenated autogenous blood and reperfusate solution at a ratio of 6:1 (6 parts blood and 1 part asanguineous solution). Beyond the pump the modified blood reperfusate solution was channeled through a heat exchanger and an arterial filter. The superficial and deep femoral arteries were each cannulated with a 10F double-lumen catheter with self-inflating balloons to allow pressure measurement during reperfusion. Controlled reperfusion flow rate was adjusted by the roller pump at 150 to 250 mL/min. Intravascular pressure in each vessel was less than 60 mm Hg. Reperfusion was stopped after 30 minutes of infusion.

Sixteen patients (84%) survived and were discharged with functional limbs. There were no renal, cardiac, pulmonary, cerebral, or hemodynamic complications in the survivors. The three deaths occurred in patients who were in profound cardiogenic shock preoperatively undergoing controlled limb reperfusion.

These findings show that our strategy of controlled arterio-arterial limb reperfusion may reduce the reperfusion injury and may salvage severely ischemic limbs.

References

  1. Greason KL, Hemp JR, Maxwell JM, Fetter JE, Moreno-Cabral RJ. Prevention of distal limb ischemia during cardiopulmonary support via femoral cannulation. Ann Thorac Surg 1995;60:209–10.[Abstract/Free Full Text]
  2. Beyersdorf F, Mitrev Z, Ihnken K, et al. Controlled limb reperfusion in patients having cardiac operations. J Thorac Cardiovasc Surg 1996;111:873–81.[Abstract/Free Full Text]




This Article
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