The management of descending thoracic aortic aneurysms using heparinless femoral venoarterial bypass.

In an attempt to use the benefits of controlled circulatory bypass, while avoiding systemic heparinization and bypass circuitry placed in the operative field, we used heparinless femoral venoarterial bypass without an oxygenator for resection of aneurysms of the descending thoracic aorta. Since 1974 we have applied this technique on 29 patients with excellent results (survival 27-29, 93 percent). Using PPG tubing, mixed venous blood was drained from the right atrium by way of a long catheter inserted via the femoral vein, and returned to the femoral artery by a roller pump. Advantages include distal aortic perfusion, a safety factor in avoiding spinal cord ischemia; preload control, helpful in managing proximal aortic hypertension; avoidance of heparinization; an operative field free of bypass circuitry; and the operation can be performed in an unhurried fashion.