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Ann Thorac Surg 2008;86:1400. doi:10.1016/j.athoracsur.2008.03.083
© 2008 The Society of Thoracic Surgeons
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Correspondence

Perfusion of the Lower Part of the Body During Open Aortic Arch Surgery

Roberto Gaeta, MD, Salvatore Lentini, MD, Francesco Monaco, MD, Fabrizio Tancredi, MD, Marcello Savasta, MD

Cardiac Surgery Unit, AOU Policlinico G. Martino, University of Messina, Viale Gazzi "Cardiochirurgia Policlinico Universitario Messina", Messina, 98168 Italy

(Email: fmonaco{at}unime.it).

To the Editor:

We read with interest the article by Panos and colleagues [1] about a technique for performing aortic arch surgery under mild hypothermia. During open aortic arch repair the authors continue to perfuse the lower part of the body by insertion of a cannula (DLP 91037) inside the descending aorta. The balloon on the tip of the cannula is inflated. Then perfusion starts after proving the seal of the lumen.

Many authors have suggested similar techniques [2–3]. The devices used are different, but all the reports are based on the same principle (ie, perfusion of the lower body to avoid or reduce the adverse effects of hypothermia). Blood flow to the lower body was achieved by means of a Foley catheter [2], an endotracheal cannula [4], or an aortic balloon (Robisceck-Pruitt) with retrograde arterial perfusion [5].

We also use a similar technique during open aortic arch replacement. We follow Touati and colleagues' [5] description. Our experience is small with only 8 patients so far, but it has been completely satisfactory in terms of clinical results. We use an aortic balloon occluder (40 mm in diameter, 7-French type, Equalaizer Baloon Catheter [Boston Scientific, Natick, MA]), inserted inside the descending aorta, and we cannula a femoral artery to retrograde to perfuse the lower part of the body. During perfusion there were no problems with misplacement of the balloon, and arterial blood pressure was maintained at 60 mm Hg. Therefore, we also suggest this technique as an alternative to the one proposed by Panos and colleagues [1].


   References
Top
 References
 

  1. Panos A, Myers PO, Kalangos A. Novel technique for aortic arch surgery under mild hypothermia Ann Thorac Surg 2008;85:347-348.[Abstract/Free Full Text]
  2. Novitzky D, Izzo EG, Alkire MJ, Brock JC. Repair of acute ascending aorta-arch dissection with continuous body perfusion: a case report Heart Surg Forum 2002;6:43-46.[Medline]
  3. Nappi G, Maresca L, Torella M, Cotrufo M. Body perfusion in surgery of the aortic arch Tex Heart Inst J 2007;34:23-29.[Medline]
  4. Touati GD, Marticho P, Farag M, et al. Totally normothermic aortic arch replacement without circulatory arrest Eur J Cardiothorac Surg 2007;32:263-268discussion 268.[Abstract/Free Full Text]
  5. Touati GD, Roux N, Carmi D, et al. Totally normothermic aortic arch replacement without circulatory arrest Ann Thorac Surg 2003;76:2115-2117.[Abstract/Free Full Text]

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Aristotelis Panos
Ann. Thorac. Surg. 2008 86: 1400-1401. [Extract] [Full Text] [PDF]



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Ann. Thorac. Surg., October 1, 2008; 86(4): 1400 - 1401.
[Full Text] [PDF]

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