SURGICAL TREATMENT OF THORACIC AND THORACOABDOMINAL AORTIC ANEURYSMS: TECHNICAL NOTES AND THE USE OF LEFT HEART BYPASS

Objective: The aim of this study was to analyze perioperative
morbidity and mortality in patients undergoing thoracic and
thoracoabdominal aortic aneurysm surgery at the Department of
Vascular Surgery of IRCCS San Raffaele, Milan.
Methods: The study included 332 patients (256 males and 76
females) with a mean age of 65 (range from 34 to 82 years) undergoing
333 operations for aneurysmectomy of thoracic and thoracoabdominal
aortic aneurysm between January 1988 and October 2002.
Cerebrospinal fluid drainage was used in 212 cases (75% of
thoracoabdominal aortic aneurysms, 53% of thoracic aortic aneurysms);
215 patients (110 thoracoabdominal aortic aneurysms and 105 thoracic
aortic aneurysms) were operated under left heart bypass using a
Biomedicus pump.
Results: The overall mortality rate at 30 days was 40/332 (12%); a
total of 32 deaths (10.5%) were recorded during elective surgery and
eight (29.6%) in patients undergoing emergency repairs. The following
perioperative complications were reported: paraplegia/paraparesis in 21
cases (6.3%), respiratory failure requiring prolonged intubation in 79
cases (24%), cardiac complications (major arrhythmia, myocardial
infarction) in 29 cases (9%), renal failure in 23 cases (7%), postoperative
bleeding requiring redo surgery in 17 cases (5%), graft infection in six
cases (1.8%).
Conclusions: Morbidity and mortality consequent to
thoracoabdominal aortic aneurysm and thoracic aortic aneurysms
surgery are still high. However, based on our experience, the use of an
active distal circulatory support, sequential cross-clamping and
cerebrospinal fluid drainage enables acceptable results to be achieved
and reduces complications secondary to spinal cord and visceral ischemia,
without the need for expeditious clamping times.