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Ann Thorac Surg 1988;46:147-154
© 1988 The Society of Thoracic Surgeons


Articles

Surgery of the Descending Thoracic Aorta: Spinal Cord Protection with the Gott Shunt

Alain Verdant, M.D., F.R.C.S.(C)*, Arthur Pagé, M.D., F.R.C.S.(C), Robert Cossette, M.D., F.R.C.S.(C), Léon Dontigny, M.D., F.R.C.S.(C), Pierre Pagé, M.D., F.R.C.S.(C), Richard Baillot, M.D., F.R.C.S.(C)

From the Division of Cardiovascular and Thoracic Surgery, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Que, Canada

* Address reprint requests to Dr. Verdant, 12245, Grenet #303, Montreal, Que, Canada H4J 2J6.

From July, 1974, to July, 1987, surgical treatment of descending thoracic aortic aneurysms was performed in 173 patients at l'Hôpital du Sacré-Coeur de Montréal. The cause of the aneurysms was arteriosclerosis or medial degeneration in 83 patients, trauma in 50, dissection in 34, and a congenital malformation in 6. A single method of external shunting provided distal perfusion in all patients in the series. A 9-mm Gott aneurysm shunt was placed preferentially between the ascending aorta (67%) and the descending aorta (60%). Alternative sites of proximal cannulation (aortic arch, 9%; proximal descending aorta, 22%; left ventricle, 2%) and distal cannulation (abdominal aorta, 3%; left femoral artery, 37%) were chosen based on the location and the extent of the aortic aneurysm. No systemic heparinization was used. In the last 40 patients, a flowmeter adapted for use with the shunt allowed the recording of shunt flow (mean, 2,475 ml/min; range, 1,100 to 4,000 ml/min). Hospital mortality, including patients with ruptured aneurysms, was 15% (26/173). The mean aortic cross-clamp time was 37 minutes (range, 8 to 105 minutes). Of the 173 patients, 168 survived long enough to allow accurate clinical evaluation of the function of the spinal cord: no paraplegia or other spinal cord ischemic injury occurred. To date, our clinical experience has demonstrated the effectiveness of the 9-mm Gott shunt in preserving the functional integrity of the spinal cord during cross-clamping of the thoracic aorta.




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