Surgical Management of Dissecting Aneurysm; The Use of a Simplified Bypass

The alarming mortality in cases of dissecting aneurysm of the aorta has stimulated the development of a surgical technique which results in re-entry of the dissecting channel. During the operative procedure prolonged cross-clamping of the aorta is necessary. While hypothermia will provide protection to the spinal cord and kidneys during reasonable periods of aortic occlusion it will not relieve back pressure on the left ventricle. By the use of a simple bypass blood is drained from the left atrium into a reservoir and then pumped into the lower aorta via the femoral artery. Thus an adequate supply of oxygenated blood is delivered to the spinal cord and kidneys distal to the occlusion while the left ventricular pressure is decompressed to normal levels. The volume of the shunted blood is simply controlled by monitoring the brachial artery pressure with a cuff sphygmomanometer. This simplified bypass has permitted successful repair of a dissecting aneurysm with complete occlusion of the thoracic aorta for a period of two hours.