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Ann Thorac Surg 1983;35:58-69
© 1983 The Society of Thoracic Surgeons
From the Division of Cardiovascular and Thoracic Surgery, Department of Surgery, School of Medicine, University of Alabama, Birmingham, AL
* Address reprint requests to Dr. Kouchoukos, 1318 S 19th St, Birmingham, AL 35205
We have reviewed our experience with resection of 85 aneurysms of the descending thoracic aorta during a ten-and-one-half year interval ending in June, 1980. There were 39 arteriosclerotic aneurysms, 35 aneurysms associated with chronic aortic dissection, and 11 posttraumatic aneurysms. During repair, a temporary shunt was used in 56 patients (66%), partial (venoarterial) cardiopulmonary bypass (CPB) in 19 patients (22%), and simple aortic cross-clamping in 10 patients (12%). Hospital mortality was 11.8%, and was unrelated to the type of aneurysm or operative method. Spinal cord injury developed in 3 of the 83 patients surviving operation (3.6%), and occurred once with each of the three operative methods. Among the 82 operative survivors without preoperative renal failure, postoperative renal failure requiring hemodialysis occurred in 2 of the 10 patients who had simple aortic cross-clamping (20%), 2 of the 54 who had a shunt (3.7%), and in none of the 18 who underwent partial CPB (p = 0.049). Postoperative renal dysfunction (a rise in the preoperative blood urea nitrogen and creatinine levels of 50% or more) occurred in 27 of the 53 patients (51%) who had preoperative and postoperative determinations. Age, intraoperative hypotension, and the use of simple aortic cross-clamping were significant (p < 0.05) independent predictors of postoperative renal dysfunction. Intraoperative blood loss and the incidence of reoperation for bleeding did not differ significantly among the three operative methods. We conclude that the aneurysm resection technique and the development of intraoperative hypotension have an important effect on postoperative renal function. Partial CPB may represent the optimal method for preservation of renal function, and may also be the method of choice for elderly patients with preexisting renal dysfunction.
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