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The Annals of Thoracic Surgery, Vol 39, 37-46, Copyright © 1985 by The Society of Thoracic Surgeons
JJ Livesay, DA Cooley, RA Ventemiglia, CG Montero, RK Warrian, DM Brown and JM Duncan
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 less
than 0.05). The risk of renal failure was increased by advanced age and
atherosclerotic cause (p less than 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.
ARTICLES
Surgical experience in descending thoracic aneurysmectomy with and without adjuncts to avoid ischemia
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