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Case Reports in Vascular Medicine
Volume 2011, Article ID 497940, 3 pages
http://dx.doi.org/10.1155/2011/497940
Case Report

Emergency Abdominal Aortic Aneurysm Repair in a Patient with Failing Heart: Axillofemoral Bypass Using a Centrifugal Pump Combined with Levosimendan for Inotropic Support

1Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital, 128 08 Prague, Czech Republic
2Department of Surgery, Central Military Hospital, 169 02 Prague, Czech Republic
3Department of Anesthesiology and Resuscitation, Na Homolce Hospital, 150 21 Prague, Czech Republic

Received 20 September 2011; Accepted 10 October 2011

Academic Editors: E. Minar, G. L. Tripepi, and S. Yamashiro

Copyright © 2011 Pavel Michalek et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We describe the case of an 83-year-old patient requiring repair of a large symptomatic abdominal aortic aneurysm (AAA). The patient was known to have coronary artery disease (CAD) with symptoms and signs of significant myocardial dysfunction, left-heart failure, and severe aortic insufficiency. The procedure was performed with the help of both mechanical and pharmacological circulatory support. Distal perfusion was provided by an axillofemoral bypass with a centrifugal pump, with dobutamine and levosimendan administered as pharmacological inotropic support. The patient's hemodynamic status was monitored with continuous cardiac output monitoring and transesophageal echocardiography. No serious circulatory complications were recorded during the perioperative and postoperative periods. This paper suggests a potential novel approach to combined circulatory support in patients with heart failure, scheduled for open abdominal aortic aneurysm repair.