Surgical Results of Pararenal Abdominal Aortic Aneurysm Repair Using Partial Cardiopulmonary Bypass

Abstract

Objective: This study aimed to evaluate the surgical results of pararenal abdominal aortic aneurysm (AAA) repair using partial cardiopulmonary bypass. Methods: Between June 2009 and April 2012, we performed graft replacement in 10 patients with pararenal AAA using partial cardiopulmonary bypass. The median age was 74 years with 90% men. The etiologies of pararenal AAA were atherosclerotic aneurysm in 7 and pseudoaneurysm at the proximal anastomosis due to previous graft replacement of infrarenal AAA in the remaining 3 patients. Thoracoretroperitoneal incision was made through the 7th intercostal space. The diaphragm was incised circumferentially at the periphery from the line of incision around to the aortic hiatus. The abdominal viscera and left kidney were rotated medially, and the abdominal aorta was then exposed. After establishment of partial cardiopulmonary bypass via the femoral artery and vein, distal perfusion and selective visceral perfusion including the renal arteries were performed. Results: Beveled anastomosis at the proximal site was performed to preserve the celiac artery and inferior mesenteric artery in all patients. Reconstruction of the left renal artery was performed in 4 patients, right renal artery in 2, and bilateral renal arteries in 1. No renal revascularization was required in 2 patients. Mean cardiopulmonary bypass time, visceral artery perfusion time, and reconstructed renal artery perfusion time were 128±48 minutes, 60±33 minutes, and 116±22 minutes, respectively. There were no in-hospital deaths or postoperative complications, except for dysuria due to spinal cord ischemia in one patient. Discussion: Graft replacement using partial cardiopulmonary bypass for pararenal AAA is a safe and effective operation without causing visceral organ ischemia.