Abstract
To avoid prolonged extracorporeal circulation, we have introduced selective visceral shunting instead of selective visceral perfusion for organ protection during thoracoabdominal aortic operation, and described our shunt circuit and clinical results. Among 47 patients who underwent thoracoabdominal aortic operation between 1991 and September 1998, 40 required reconstruction of the abdominal branches. Of these patients, 18 underwent selective visceral perfusion, 6 underwent selective visceral shunting, and perfusion was converted to the shunt in 4 additional patients. The shunt circuit consists of a 10 mm heparin-bound tube with four independent 6 mm side branches, and provides a free flow of 280 ml/min at 80 mmHg when a 12 Fr balloon catheter is connected. Extracorporeal circulation was terminated after completion of intercostal reconstruction, and the shunt was established and heparin was partially neutralized. A branch of the aortic prosthesis was used as an inflow. No complications related to the use of shunt were noticed. Postoperative hepatic and renal function was satisfactory, as compared with that provided by selective visceral perfusion, which was performed at a rate of 175±35 ml/min/branch under partial cardiopulmonary bypass. Despite the flow limit dependent on hemodynamics, the clinical results of organ protection provided by selective visceral shunting were satisfactory.
