Original Article

Prolonged CPB in Patients Requiring Extensive Coronary Endarterectomy and Reconstruction

Milwaukee Heart Surgery Associates, Milwaukee, WI

^* Address correspondence to: Michael Harloff, Milwaukee Heart Surgery Associates, 2315 N. Lake Drive, Suite 1007, Milwaukee, WI 53211

Abstract

The technique of coronary endarterectomy and reconstruction continues to be a tedious and time consuming effort. A 14 cm. endarterectomy of a diffusely diseased LAD, with accompanying diagonal branches and septal perforators, can require as long as 90-115 minutes of aortic clamp time. Multiple endarterectomies, including marginal branches of the circumflex system as well as multiple branches of the right coronary system, can consume an additional 100-125 minutes of aortic clamp time. It is not uncommon for total clamp time to exceed 200 minutes. Because of the totally occlusive nature of the disease, cardioplegia is impossible to deliver. As a result, the method of intermittent ischemic arrest proves to be the technique of choice. It has become necessary to develop a perfusion protocol which will support the surgical procedure that can last a total of 300 to 420 minutes on CPB. Hollow-fiber membrane oxygenation, normal physiological arterial and venous gases, and scrupulous attention to the CPB circuit, is imperative if the patient is to derive a long term benefit from the procedure. The conduct and technique of CPB which has been developed with Milwaukee Heart Surgery Associates has allowed the surgeons the time and margin of safety required to perform coronary endarterectomy and reconstruction.