Left Heart Bypass

Simple cross-clamping of the descending thoracic aorta produces visceral ischemia, particularly at the level of the spinal cord and the kidneys, and stresses the heart due to an abrupt increase of the after-load. Several methods of distal aortic perfusion have been developed to reduce end-organ ischemia, to support the heart, and control proximal hypertension during open repair of thoraco-abdominal aneurysms. This chapter analyzes the advantages and drawbacks of the different techniques, with a particular focus on left heart bypass: materials and techniques are described, including the recent improvements from the San Raffaele experience in thoracoabdominal aortic surgery. Many factors contribute to the success or failure of the procedure; however, the overall improvement in clinical results is likely to be due to the synergistic effect of many small variations in the use of surgical and anesthetic techniques and technological adjuncts including extracorporeal circulation. The contribution of better materials as well as a more rational use of existing technologies and techniques is pivotal.