Hypothermic circulatory arrest for thoracic aneurysmectomy through left-sided thoractomy
| Autor: | Marie-Hélène Fléron, Gilles Godet, Fabien Koskas, Edouard Kieffer, Michèle Bertrand, Raphael Walden, Amine Bahnini, Dominique Le Blevec |
|---|---|
| Rok vydání: | 1994 |
| Předmět: |
Adult
Male Aortic arch medicine.medical_specialty Aortic Rupture medicine.medical_treatment Blood Loss Surgical law.invention Postoperative Complications Aneurysm Hypothermia Induced law Cause of Death medicine.artery Ascending aorta medicine Cardiopulmonary bypass Humans Thoracic aorta Thoracotomy Aged Cardiopulmonary Bypass Aortic Aneurysm Thoracic business.industry Anastomosis Surgical Perioperative Middle Aged medicine.disease Blood Vessel Prosthesis Surgery Survival Rate Aortic Dissection Treatment Outcome Anesthesia Heart Arrest Induced cardiovascular system Female Cardiology and Cardiovascular Medicine Paraplegia business Aortic Aneurysm Abdominal |
| Zdroj: | Journal of Vascular Surgery. 19:457-464 |
| ISSN: | 0741-5214 |
| Popis: | Purpose: In an attempt to clarify the role of hypothermic circulatory arrest (HCA) in the management of complex aortic aneurysms operated on through the left thoractomy, our technique of HCA and outcome were reviewed. Methods: During a 21-month period, 15 (17%) of 87 aneurysms of the descending thoracic or thoracoabdominal aorta were operated on by HCA. Eleven patients had chronic aortic dissections (four type A and seven type B), two patients had atherosclerotic aneurysms, and one each had congenital or infected postoperative aneurysms. The use of HCA was planned before surgery in 14 patients. Indications included proximal aortic disease in 12 patients, making either clamping of the transverse aortic arch unsafe (eight patients) or necessitating replacement of the arch with a graft (four patients). Preoperative decision to use HCA was made in two additional patients, one with a ruptured aneurysm and another patient for spinal cord and visceral protection because of anticipated prolonged ischemia as a result of reoperation. Intraoperative technical difficulties prompted the use of HCA in only one patient. Deep hypothermia (15° to 24° C) was induced through partial cardiopulmonary bypass. Left-sided heart venting was necessary in five patients. Aortic replacement was limited to the descending thoracic aorta in five patients, whereas it involved the thoracoabdominal aorta in 10 patients. Four patients had associated replacement of the aortic arch. Results: Three patients died (one of a ruptured aneurysm) during surgery or early after surgery (two of bleeding and one of left ventricular failure). All other patients awoke neurologically intact, but one patient had delayed onset of paraplegia. Another patient died 4 days after surgery of rupture of the ascending aorta. Eleven patients were perioperative survivors without significant morbidity. Conclusions: Hypothermic circulatory arrest is a valuable adjunct in the management of complex aortic aneurysms through left-sided thoractomy. Its results warrant consideration of its selective use for spinal cord/visceral protection. (J VASC SURG 1994;19:457-64.) |
| Databáze: | OpenAIRE |
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