"Interventions on the thoraco-abdominal aorta have a longer aortic clamping time and complex intraoperative problems resulting from disruption of blood circulation to the spinal cord and intraabdominal visceral arteries and from hemodynamic stress (heart and brain). To minimize the risk of spinal, abdominal, renal or cerebral damage, partial bypass techniques should be used. Because of the serious disadvantage of the systemic heparinization (increased peri- and postoperative bleeding tendency) when using extracorporeal circulation technique, it is used with caution in descending or thoraco-abdominal aortic replacement. However, in patients with extensive aortic disease localized in the distal aortic arch, the descending and thoraco-obdominal aortic region, elective use of the extracorporeal circulation in combination with circulatory arrest in deep hypothermia offers a therapeutic option.
Increasingly, aneurysms of the descending aorta or type B dissections are interventionally treated with endoluminal stent grafts and this procedure has led to an extension of treatment options.
The surgery of thoracic aneurysms and dissections is a demanding and highly complicated procedure, whereby reconstructive and valve-sparing techniques are increasingly used in the area of the aortic root. Intraoperatively implantable stent grafts or stented aortic prostheses will gain clinical importance in the future. The question of maximum protection of neural tissue or a simple surgical procedure has not yet been clearly answered. For each patient, the individual local conditions and risks of the pathological aortic findings must be carefully clarified and examined prior to the surgical intervention in order to be able to select and apply the optimal therapy in each individual case."
Tschaut, Dreher, Rosenthal, Walczak (Eds.)
Extracorporeal Circulation in Theory and Practice
Pabst, Hardcover
ISBN 978-3-95853-545-9, e-book ISBN 978-3-95853-546-6