Watanabe S I, Hayashi K, Yamanishi H, Tomioka H, Minami M, Shindo N, Miyamoto K
Department of Cardiovascular Surgery, Hokko Cardiovascular Hospital, Sapporo, Japan.
Kyobu Geka. 1997 May;50(5):362-7.
Non emergency use of heparin-coated percutaneous cardiopulmonary support (PCPS) in cardiovascular surgery was applied in 4 patients (3 patients with descending aortic aneurysm, and one with aortic valvular stenosis and impaired left ventricular contractility (LVEF = 0.18). In aortic surgery, femoral inflow and outflow cannulae were inserted after introduction of anesthesia, and low flow F F bypass was established with the patient in supine position. Subsequently lateral posture was taken for aortic grafting. Activated clotting time was kept around 200 sec during the whole operative period and F F bypass was continued after the grafting procedure, and the cannulae were removed when the patient posture was returned to supine. With this method cannulation and decannulation were easy, and almost prone position, which was sometimes necessary for dissection of the adhesion of lung to the posterior aspect of the aneurysmal wall, was easily performed. Because of the percutaneous insertion, there was no local hemorrhage in the groin. Heparin coating circuit permitted only low grade systemic anticoagulation during the operative period, which could lead to decreased amount of hemorrhage. Long F F bypass without full heparinization made no harmful effect on patients' coagulability nor their hemodynamic status. For the patient with extremely impaired cardiac contractility, "scheduled PCPS and IABP" was proved to be safe, reliable, and cost-effective: F F bypass was established before sternotomy, and intracardiac procedure with aortic crossclamping was performed under total cardiopulmonary bypass using PCPS. After declamping of the aorta, weaning from the bypass was not tried and total anticoagulation was reversed with protamine. Then the sternum was closed and patient was transferred to ICU with the PCPS and IABP on. After more than 10 hours, when the cardiac contractility recovered from the intraoperative ischemic insult to a considerable degree, weaning from PCPS was successfully accomplished.
