Femoro-axillary cardiopulmonary bypass for giant abdominal aortic aneurysm repair prior to staged cardiac operation for ischaemic cardiomyopathy

Abstract

The optimal surgical management of simultaneous abdominal aortic aneurysm and cardiac disease remains a major challenge in case of larger aneurysms and severe cardiac disease. In case of symptomatic aneurysms or impending rupture, a single-stage combined operation is the most widely accepted procedure. We report the successful use of closed-chest cardiopulmonary bypass, with femoral venous and axillary arterial peripheral cannulation, to support cardiac function on the beating heart during resection of a giant abdominal aortic aneurysm and ischaemic cardiomyopathy. One month later, the patient underwent a second-stage deferred cardiac operation, consisting of triple coronary bypass grafting, undersized mitral annuloplasty and epicardial left ventricular lead implantation for cardiac resynchronisation therapy.

Giant abdominal aortic aneurysms

“…These common comorbid conditions also matched findings in other studies. [5] , [6] Unique comorbid conditions included Takayasu arteritis [8], Marfan syndrome [9], Behçet disease [10,11], a Jehovah's witness requiring autologous transfusion [12], and ischemic cardiomyopathy requiring cardiopulmonary bypass during AAA repair [13].…”

“… 5 , 6 Unique comorbid conditions included Takayasu arteritis, 8 Marfan syndrome, 9 Behçet disease, 10 , 11 a Jehovah's witness requiring an autologous transfusion, 12 and ischemic cardiomyopathy requiring cardiopulmonary bypass during AAA repair. 13 Complete data for the included cases are listed in the Supplementary Table (online only).…”

“… 15 , 22 , 23 , 24 One patient refused surgical intervention and was treated nonoperatively. Complications were reported in 13 cases (32.5%) and included perigraft seroma, 25 ischemic colitis, 13 , 26 acute respiratory distress syndrome, 1 and renal failure. 3 …”

“…[15,33,35,40] One patient denied surgical intervention and was managed non-operatively. Thirteen cases reported complications including perigraft seroma [22], ischemic colitis [13,23], ARDS [1], and renal failure [3].…”

A systematic review and case presentation: Giant abdominal aortic aneurysm

“…15,64 With open laparotomy, aortic cross-clamping is frequently difficult, and decreased surgical exposure can lead to unwanted traction upon the aneurysm neck or adjacent organs leading to increased venous injury, pancreatitis, and bowel injury may occur. 65 Simultaneously occurring conditions make AAA management challenging such as concomitant aortic dissection – case presented by Xu et al, 66 diverticular abscess, and abdominal aortic aneurysm, where percutaneous drainage of the abscess under ultrasound guidance was performed to drain abscess – Al Wahbi and Tamimi 67 horseshoe kidney, 62 in a Jehovah’s Witness, use of blood obtained by continuous cell salvage technique and the sixth postoperative day, recombinant human erythropoietin (epoetin beta) was commenced, 68 staged cardiac operation for ischaemic cardiomyopathy and performing abdominal aneurysmectomy first on cardiopulmonary bypass – mildly hypothermic (34° 8C) full-flow bypass by Pocar et al 69 Utilization of hypothermic cardiac bypass – Vural et al 70 suggest it as a useful method in giant AAA, operations where simple aortic clamping is not sufficient for AAA repair and repair of diseases TAA and AAA performing anastomosis with a bloodless surgical field without proximal clamping. 71–73 Complications were reported in cases 21 (35%) including multi-organ failure, ARDS, paralytic ileus, wound infection/dehiscence, ischaemic colitis, jaundice erectile dysfunction, gastric erosions, perigraft seroma, and graft infection enlisted in Table 3.…”