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Eur J Cardiothorac Surg 1999;15:502-507
© 1999 Elsevier Science NL

Selective visceral and renal perfusion in thoracoabdominal aneurysm repair¹

Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo 060-8556, Japan

Received 22 September 1998; received in revised form 1 February 1999; accepted 2 February 1999.

Corresponding author. Tel: +81-11-611-2111, ext. 3314; fax: +81-11-613-7318

Objective: Whether or not selective visceral and renal perfusion during thoracoabdominal aortic aneurysm (TAAA) repair has a protective effect on visceral and renal function remains unknown. The aim of this study was to clarify if selective perfusion has such an effect. Methods: From May 1982 to December 1997, 82 consecutive patients underwent TAAA repair. Patients receiving hypothermic circulatory arrest or cooling of the kidney using Ringer's lactate solution were excluded, thus 73 patients were enrolled into this study. They were divided into three groups: those in whom selective visceral and renal perfusion was performed using a roller pump (n=41), those in whom it was performed using a centrifugal pump with a reduced heparin regimen (n=22) and those who underwent simple aortic clamping alone (n=10). Results: Serum creatinine, total bilirubin and alanine aminotransferase levels were elevated postoperatively in patients undergoing simple cross-clamp repair, but remained almost within normal limits in patients undergoing TAAA repair with selective visceral and renal perfusion. Urine output was more in selective perfused patients than in non-perfused patients. Renal dysfunction, defined by requirement of hemodialysis or by a serum level of creatinine above 3 mg/dl, occurred in four patients (10%) of the roller pump group and in two patients (9%) of the centrifugal pump group, while in four patients (40%) of the simple cross-clamping group. Conclusion: Our experience suggests that selective visceral and renal perfusion has a protective effect on hepato-renal function during TAAA repair.

Key Words: Thoracoabdominal aortic aneurysm • Selective visceral and renal perfusion • Visceral ischemia-reperfusion • Hepato-renal function