Application Of Normothermic Cardiopulmonary Bypass In The Treatment Of Complex Abdominal Aortic Aneurysm

Purpose:To summarize the application experience of normothermic cardiopulmonary bypass in the open surgery of complex abdominal aortic aneurysms.Methods: From September 2011 to September 2016,12 patients with complex abdominal aortic aneurysms underwent open surgery at the Second Hospital of Jilin University.Aneurysms involved the celiac,superior mesenteric artery or bilateral renal artery in 6 cases.Another 6 cases were ruptured,including 2 limited ruptured abdominal aortic aneurysm and 4 open ruptured abdominal aortic aneurysm.Six patients with aneurysms involving abdominal celiac trunk,superior mesenteric artery,or bilateral renal artery,underwent thoracoabdominal incision.With normothermic cardiopulmonary bypass,the aorta was segmentally blocked and celiac arteries were selectively perfused.Four branch arterial vessels were used in aortic replacement.In 2 patients with limited ruptured abdominal aortic aneurysm,it could not directly block the aorta below the renal artery because the aneurysm was so close to the renal artery.They are performed thoracoabdominal incisions to block the aorta between the superior mesenteric artery and bilateral renal arterise with normal blood continuously perfusing bilateral renal arterise.The remaining 4 cases of open ruptured abdominal aortic aneurysm uderwent emergency operations for continuous reduced blood pressure,and all used ECC pipelines for blood transfusion through the bridge between the arteriovenous pipeline connection.Record surgical methods,operation time,ECC time,blocking time,hospitalization time and complications.Results:8 patients underwent surgeries with mean operation time(9.2±1.4)h,ECC time(107.5±30.9)min,abdominal aorta occlusion time(79.7 ± 26.3)min and hospitalization days(20.8±4.9)d.Another 4 patients used ECC pipelines for blood transfusion and successfully recovered and maintained cyclic stability.One patient suffered multiple organ failure after infection and eventually died of septic shock.Renal insufficiency occurred in 4 patients who had preoperative mild creatinine elevation and all patients were cured under CRRT.All patients did not occur respiratory,digestive,neurological complications,survive in follow-up 1-4 years,the treatment effect is satisfactory.Conculsions : The surgical application of normothermic cardiopulmonary bypass in the treatment of complex abdominal aortic aneurysms can ensure the blood supply of vital organs and maintain the good intraoperative hemodynamics,and the operation effect is good.