Left Atrial to Femoral Artery Full Cardiopulmonary Bypass: A Novel Technique for Descending and Thoracoabdominal Aortic Surgery

• Published in: The International journal of angiology 2020-03, Vol.29 (1), p.019-026
• Main Authors: Papanikolaou, Dimitra, Savio, Chris, Zafar, Mohammad A., Freudzon, Leon, Wu, Jinlin, Abdelbaky, Mohamed, Pelletier, Keith J., Buntin, Joelle, Faggion Vinholo, Thais, Ziganshin, Bulat A., Schwartz, Brian, Elefteriades, John A.
• Format: Article
• Language: English
• Subjects: Original; Original Article
• ISSN: 1061-1711; 1615-5939
• DOI: 10.1055/s-0039-3400479

Abstract Left atrial-femoral artery (LA-FA) bypass with a centrifugal pump and no oxygenator is commonly used for descending and thoracoabdominal aortic (DTAA) operations, mitigating the deleterious effects of cross-clamping. We present our initial experience performing DTAA replacement under LA-FA (left-to-left) cardiopulmonary bypass (CPB) with an oxygenator. DTAA replacement under LA-FA bypass with an oxygenator was performed in 14 consecutive patients (CPB group). The pulmonary vein and femoral artery (or distal aorta) were cannulated and the full CPB machine were used, including oxygenator, roller pump, pump suckers, and kinetically enhanced drainage. The CPB group was compared with 50 consecutive patients who underwent DTAA replacement utilizing traditional LA-FA bypass without an oxygenator (LA-FA group). Perioperative data were collected and statistical analyses were performed. All CPB patients maintained superb cardiopulmonary stability. The pump sucker permitted immediate salvage and return of shed blood. Superb oxygenation was maintained at all times. High-dose full CPB heparin was reversed without difficulty. The CPB group required markedly fewer blood transfusions than the LA-FA group (2.21 vs. 5.88 units, p