Early and late results of descending thoracic and thoracoabdominal aortic aneurysm open repair with deep hypothermia and circulatory arrest.

Abstract

OBJECTIVE:

Open repair of descending thoracic aortic and thoracoabdominal aortic aneurysms may carry low morbidity and mortality, depending on experience of the surgeon and operative technique used. Although thoracic endovascular aortic repair is less invasive, its limitations include anatomy and pathology of the aorta, proximity of major branches, and significant complication and reintervention rates. We retrospectively reviewed a 2-surgeon experience (J.W.F. and J.S.C.) with deep hypothermic circulatory arrest to repair descending thoracic aortic and thoracoabdominal aortic aneurysms.

METHODS:

All patients (n = 343) who underwent surgical replacement of descending thoracic aortic or thoracoabdominal aortic aneurysm with deep hypothermic circulatory arrest from 1995 to 2009 were included. Segmental arteries between T8 and the celiac artery were aggressively reimplanted as indicated. Visceral and renal artery bypasses were performed for significant stenosis. Concomitant coronary artery bypass grafting was performed if targets were anterior or lateral wall vessels. Lumbar drains were not routinely used but placed postoperatively on clinical evidence of spinal cord ischemia.

RESULTS:

Of 343 patients, 98 had descending thoracic aortic aneurysms, 69 had Crawford type I thoracoabdominal aortic aneurysms, 111 had type II, 32 had type III, and 33 had type IV. Emergency or urgent operations comprised 13% of repairs. Hospital mortalities were 5.0% for all cases, 3.7% for elective cases, and 13.3% for urgent or emergency cases. Overall incidences were 4.4% for stroke, 3.2% for paraplegia or paraparesis, 1.5% for renal failure requiring dialysis, and 3.5% for tracheostomy. The 1-, 3-, 5-, and 10-year survival rates were 90%, 79%, 69%, and 54%, respectively.

CONCLUSIONS:

Surgical repair of descending thoracic aortic and thoracoabdominal aortic aneurysms with deep hypothermic circulatory arrest carries low operative morbidity and mortality and excellent early and late survival rates. These results can be used as a benchmark for future techniques and technologies.

• Authors: John W Fehrenbacher, Harry Siderys, Colin Terry, John Kuhn, Joel S Corvera
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 140 Issue 6 Suppl Pg. S154-60; discussion S185-S190 (Dec 2010) ISSN: 1097-685X [Electronic] United States
• PMID: 21092785 (Publication Type: Journal Article)
• Copyright: Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Topics

• Aged
• Aortic Aneurysm, Thoracic (mortality, surgery)
• Blood Vessel Prosthesis Implantation (adverse effects, mortality)
• Circulatory Arrest, Deep Hypothermia Induced
• Female
• Hospital Mortality
• Humans
• Indiana
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Paraparesis (etiology)
• Paraplegia (etiology)
• Renal Dialysis
• Renal Insufficiency (etiology, therapy)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Stroke (etiology)
• Survival Rate
• Time Factors
• Tracheostomy
• Treatment Outcome