Assessment of hepatosplanchnic pathophysiology during thoracoabdominal aortic aneurysm repair using visceral perfusion and shunt☆

Abstract

Visceral perfusion/shunt in TAAA repair may avoid critical irreversible hepatosplanchnic ischemia but provide unphysiological blood flow to the liver and thus should be shortened.

The impact of deep and moderate body temperatures on end-organ function during hypothermic circulatory arrest

“…To avoid ischaemia-related complications and potential side effects of deep temperatures, additional lower body perfusion during HCA may improve clinical results, as previously shown for abdominal aortic surgery as well as thoraco-abdominal aortic repair [23][24][25]. Furthermore, previous special antibiotic treatment to avoid peritonitis and bacteraemias may have an additional benefit.…”

Hepatopancreaticobiliary Values after Thoracoabdominal Aneurysm Repair

“…This is particularly evident in the liver, which has regional variations in the number of hepatocytes and in the ability of different hepatic cell types to withstand hypoxia. We know from metabolic studies of visceral organs protected by adjunctive measures that the resulting flow is not physiologic [6]. Although normal liver blood flow may resume as early as 4-6 h after surgery, the change in hepatocyte metabolism resulting from diminished flow may persist for longer periods [1].…”

Long-term Renal Outcomes of Consecutive Patients Undergoing Open Type IV Thoracoabdominal Aneurysm Repair

“…24 Additional measures, such as left heart bypass, balloon perfusion catheters, and shunts, have been used for selective visceral perfusion. 25,26 While these measures are undoubtedly useful for extent types I and II, the role in type IV repair is less clear. Similarly, at our centre, endarterectomy or stenting is not routinely performed in the case of renal artery stenosis.…”