Hemodynamics and prostacyclin release in the early phases of aortic surgery: Comparison of transabdominal and retroperitoneal approaches

Abstract

Although the retroperitoneal aortic approach (RP) is advocated to reduce myocardial ischemia and cardiac-related death, inadequate physiologic data exist to support this contention. As the aorta is exposed via the transabdominal approach (TA) we noted some patients have manifested reduced systemic vascular resistance (SVR) associated with tachycardia, reduced blood pressure, and facial flushing. To determine whether RP offered physiologic advantages over TA we compared cardiac dynamics and blood levels of 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), the stable metabolite of prostacyclin, during exposure of the aorta in 52 patients (33 with TA and 19 with RP), comparable in age, cardiac history, medications, and body surface area. Serial measurements of mean arterial pressure, heart rate, wedge pressure, pulmonary artery pressure, cardiac index, and 6-keto-PGF1 alpha were obtained. Results revealed decreased mean arterial pressure and systemic vascular resistance, increased cardiac index and heart rate, and facial flush occurring 10 minutes after the bowel was explored in TA. This was not observed in RP. These hemodynamic alterations correlated in time and magnitude with a fourteen fold increase in 6-keto-PGF1 alpha. These changes in cardiac indexes can produce increased myocardial oxygen consumption with the risk for myocardial ischemia, particularly in patients with coronary artery disease. The absence of this response to bowel exploration in RP may account for some of the observed advantages in "high-risk" aortic reconstruction.

Physiologic effects of pneumoperitoneum in adults with sickle cell disease undergoing laparoscopic cholecystectomy (A case control study)

“…In accordance with the present study, several investigators have demonstrated a significant increase in MAP during laparoscopic procedures [11,12]. Persistent elevation of MAP during LC may be due to many causes such as release of catecholamine and other humoral factors (dopamine [13], vasopressin [14], rennin [15], and cortisol [16] ), vasoconstriction caused by thromboxane release due to mesenteric stretching and compression of abdominal aorta by pneumoperitoneum [17], and lastly due to hypercarbia [18].…”

Comparison of Transperitoneal and Retroperitoneal Approaches in Abdominal Aortic Surgery

“…In recent years, as an alternative approach, the retroperitoneal (RP) exposure of the aorta has been advocated by many authors to avoid entering the peritoneum ; thus providing less physiologic trauma and a reduced postoperative morbidity (2)(3)(4)(5)(6)(7)(8)(9).…”

Gut barrier function and systemic endotoxemia after laparotomy or laparoscopic resection for colon cancer: A prospective randomized study

“…[ 23 ] The mucosa of the intestine and the endothelium of blood vessels contain enzymes capable of synthesizing prostaglandins, production of which may be initiated by neural, ischemic, toxic, or mechanical stimuli. [ 24 ] The generation of these vasoactive prostaglandins can therefore induce splanchnic ischemia with subsequent disruption of mucosal integrity and increased intestinal permeability. Therefore, intestinal manipulation may lead to the endotoxemia detected in the systemic circulation, in patients undergoing colorectal surgery.…”