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Received: 2 August 2022
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Accepted: 24 September 2022
DOI: 10.1111/jocs.17105
OPERATIVE TECHNIQUE
Minimizing visceral organ ischemia time for open repair
of thoracoabdominal aortic disease: Description of a
new method
Andrey V. Marchenko MD |Pavel A. Myalyuk PhD |Alexey A. Petrishchev MD
Federal Center for Cardiovascular Surgery
named after SG Sukhanov, Perm, Russian
Federation
Correspondence
Andrey V. Marchenko, MD, Federal Center for
Cardiovascular Surgery, 35 Marshala Jukova
St., Perm 614013, Russian Federation.
Email: mammaria@mail.ru
Abstract
Minimizing ischemic injury during surgical repair of thoracoabdominal aortic aneurysms
(TAAAs) is vital for preventing complications such as paraplegia and acute renal failure. In
this report, we describe a new technique for TAAA open repair that aims to minimize
visceral organ ischemia times. Unlike typical Crawford extent II TAAA open repair, which
begins with aortic clamping and proceeds from the proximal to the distal anastomoses,
our method reverses the anastomosis order and minimizes aortic clamping.
Between January 2016 and December 2020, we used this approach in 29 patients
undergoing TAAA repair. We present one of these cases, a 29‐year‐old patient with
progressive aneurysmal dilatation of a DeBakey type III chronic aortic dissection that
extended beyond the aortic bifurcation. Our technique reduced aortic cross‐
clamping, left heart bypass, and internal organ and spinal cord ischemia times and
appears to be safe and effective.
KEYWORDS
open aneurysm repair, surgical technique, thoracoabdominal aneurysm
1|INTRODUCTION
Minimizing ischemic injury during thoracoabdominal aortic aneurysm
(TAAA) repair is essential.
1–4
Here,wedescribeanewmethodofopen
TAAA repair developed and implemented at our center (Federal Center
for Cardiovascular Surgery, Perm, Russian Federation) that minimizes
visceral organ ischemia. Unlike typical Crawford extent II TAAA open
repair, which begins with aortic clamping and proceeds from the proximal
to the distal anastomoses, our method reverses the anastomosis order
and minimizes aortic clamping. We perform the distal anastomoses first,
without aortic cross‐clamping; we do not cross‐clamp the aorta until we
perform the proximal anastomosis to complete the repair (Table 1).
Between January 2016 and December 2020, we used this approach in
29 patients undergoing TAAA repair. We present our technique as
applied in one of these cases (Supporting Information: Video 1).
This report was approved by Institutional Review Board of Federal
Center for Cardiovascular Surgery (Protocol No. 12, dated February 7,
2016). The patient gave informed consent for publication of this report.
2|CASE REPORT
A29‐year‐old patient with Marfan syndrome was admitted to our
center with progressive aneurysmal dilatation of a DeBakey type III
chronic aortic dissection that extended beyond the aortic bifurcation.
We have identified on computed tomography a proximal fenestration of
the descending thoracic aorta 5 mm distal to the left subclavian artery,
and a maximum aortic size of 73 mm at the isthmus, 54 mm at the level
of diaphragm, 46 mm at the level of infrarenal aorta (Figure 1).
Before initiating repair, we established cerebrospinal fluid
drainage to mitigate spinal cord ischemia. Thoracophrenolumbotomy
was used to establish surgical access along the fourth intercostal
space, and the entire thoracoabdominal aorta, including the visceral
and iliac arteries, was mobilized. A physician‐modified “neo‐graft”
was prepared from multibranch and singular grafts (Figure 2).
Without using left heart bypass (LHB) or aortic cross‐clamping,
we then performed end‐to‐side anastomoses of the bifurcated
portion of the neo‐graft to the left and right common iliac arteries
J Card Surg. 2022;37:5666–5669.wileyonlinelibrary.com/journal/jocs5666
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