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Ann Thorac Surg 2001;71:1753
© 2001 The Society of Thoracic Surgeons

Correspondence

Simple shunting of thoracoabdominal aneurysms with visceral perfusion

Salvatore Privitera, MSca, Robert J. Cusimano, MD, MSca

a Division of Cardiovascular Surgery, The Toronto Hospital, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada

e-mail: robert.cusimano{at}uhn.on.ca

To the Editor

We read with interest the case report written by Kunitomo and associates [1] regarding thoracoabdominal aortic aneurysm repair using cardiopulmonary bypass (CPB) with selective perfusion of the viscera.

Our method for the repair of isolated thoracic and thoraco-abdominal aneurysms parallels that described by the authors, however, since April 1999, we have been doing it without the use of CPB. We incorporate a variant of the Gott shunt [2], whose reliability and safety for distal perfusion has been shown [3]. We have been able to cannulate the descending aorta or distal arch as an inflow and cannulate the distal aorta or iliac arteries as well as up to four visceral organs requiring perfusion (left and right kidneys, celiac axis, and superior mesenteric artery). In this manner, we perfuse the lower extremities and viscera and reduce the hemodynamic load on the heart during aortic cross-clamp. Intermittant occlusion of the shunt distal to the visceral bed can be performed as required to reduce the cardiovascular affects of bleeding and thereby increase proximal blood pressure so that the coronary, cerebral, and visceral perfusion pressures are maintained to a greater extent.

To shunt arterial blood around the aneurysm we use standard 8-mm Sarns (Terumo, Ann Arbor, MI) aortic cannulas interconnected with x -inch straight connectors (Baxter, Irvine, CA). A "T" to a multiple perfusion set or "octopus" (Medtronic, Grand Rapids, MI) attached to straight coronary cannuli with balloon tips (4 to 8 mm) (Polystan A/S, Walgerholm, Denmark) allows for direct perfusion of the viscera.

Distally, we have always perfused within the thoraco-abdominal cavity, and the femoral vessels can be cannulated separately if necessary. Heparinization of only 5,000 to 10,000 units was used in all cases.

We believe that this system is very easy to use, using readily available instruments without the need for specialized technicians. It can thus be utilized in centers that do not have cardiopulmonary bypass capabilities. The lungs oxygenate the blood and the circuit can be used to diminish the cardiovascular effects of cross-clamping and bleeding during the operation while maintaining visceral perfusion. We feel that this technique affords an easier and alternative approach than that taken by the authors for thoracic and thoraco-abdominal aneurysm repairs when visceral and distal perfusion are required.

References

  1. Kunitomo R., Goto H., Utoh J., Kitamura N. Thoracoabdominal aortic aneurysm combined with aortic occlusion. Ann Thorac Surg 2000;69:623-625.[Abstract/Free Full Text]
  2. Gott V.L. Heparinized shunts for thoracic vascular operations. Ann Thorac Surg 1972;14:219-220.[Medline]
  3. Verdant A., Page A., Cossette R., Dontigny L., Page P., Baillot R. Surgery of the descending thoracic aorta: spinal cord protection with the Gott shunt. Ann Thorac Surg 1995;60:1151-1152.[Free Full Text]

Related Article

Simple shunting of thoracoabdominal aneurysms with visceral perfusion: Reply
Ryuji Kunitomo
Ann. Thorac. Surg. 2001 71: 1753. [Extract] [Full Text] [PDF]




This Article
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