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Ann Thorac Surg 1985;39:37-46
© 1985 The Society of Thoracic Surgeons
From the Division of Surgery, Texas Heart Institute of St. Luke's Episcopal and Texas Children's Hospitals, Houston, TX
* Address reprint requests to Dr. Livesay, Texas Heart Institute, PO Box 20345, Houston TX 77225
Over the past twelve years, surgical treatment of descending thoracic aneurysms has been performed in 360 patients. Three different operative strategies were employed during resection to provide distal aortic perfusion by temporary bypass (Group 1, 75 patients) or shunt (Group 2, 22 patients) or to simplify the operative procedure with aortic cross-clamping alone (Group 3, 263 patients). The surgical results were determined primarily by patient-related and disease-related variables. Advanced age (older than 70 years), atherosclerotic cause, and emergency operation significantly increased the risks of early mortality and morbidity. The incidence of death (11.7%), paraplegia (6.5%), or renal failure (6%) was not reduced by the use of adjunctive perfusion, and bleeding complications increased significantly in Groups 1 and 2. Spinal cord injury was increased significantly by emergency operations, cross-clamp times exceeding 30 minutes, and extensive aneurysms (p < 0.05). The risk of renal failure was increased by advanced age and atherosclerotic cause (p < 0.05). With an experienced surgical team, the primary risks of descending thoracic aneurysmectomy are not influenced by the method of adjunctive perfusion, but are determined by patient factors such as the nature and extent of the aneurysm.
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L. H. Hollier, J. B. Symmonds, P. C. Pairolero, K. J. Cherry, J. W. Hallett, and P. Gloviczki Thoracoabdominal Aortic Aneurysm Repair: Analysis of Postoperative Morbidity Arch Surg, July 1, 1988; 123(7): 871 - 875. [Abstract] [PDF]
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M. J. Antunes Acute Traumatic Rupture of the Aorta: Repair by Simple Aortic Cross-Clamping Ann. Thorac. Surg., September 1, 1987; 44(3): 257 - 259. [Abstract] [PDF]
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T. Kazui, S. Komatsu, and H. Yokoyama Surgical Treatment of Aneurysms of the Thoracic Aorta with the Aid of Partial Cardiopulmonary Bypass: An Analysis of 95 Patients Ann. Thorac. Surg., June 1, 1987; 43(6): 622 - 627. [Abstract] [PDF]
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K. L. Mattox Clamp/Repair of Traumatic Transection of Descending Aorta: Reply Ann. Thorac. Surg., March 1, 1987; 43(3): 351 - 352. [PDF]
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K. H. Lim, M. Connolly, D. Rose, F. Siegman, I. Jacobowitz, A. Acinapura, and J. N. Cunningham Jr. Prevention of Reperfusion Injury of the Ischemic Spinal Cord: Use of Recombinant Superoxide Dismutase Ann. Thorac. Surg., September 1, 1986; 42(3): 282 - 286. [Abstract] [PDF]
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A. Verdant Descending Thoracic Aneurysmectomy Ann. Thorac. Surg., October 1, 1985; 40(4): 414 - 414. [PDF]
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