Does cross-clamping the arch increase the risk of descending thoracic and thoracoabdominal aneurysm repair? Academic Article uri icon

Overview

abstract

  • BACKGROUND: Descending thoracic and thoracoabdominal aortic aneurysms may arise in the distal aortic arch. Repair of these aneurysms has been associated with increased morbidity and operative mortality. Complex surgical and endovascular techniques have reduced the risks for this cohort. We examined outcomes utilizing an approach based on simple cross-clamping of the arch. METHODS: From July 1997 to January 2004, 272 consecutive patients had aneurysm repair through the left chest. Twenty-nine requiring profound hypothermic circulatory arrest (PHCA) were excluded. Two hundred and forty-three were divided into two groups: group I (n = 60) had distal arch involvement and required cross-clamping proximal to the left subclavian artery. Group II (n = 183) were cross-clamped distal to the subclavian. Adjuncts for neurologic and renal protection were utilized as needed. RESULTS: In-hospital mortality for all 243 patients was 3.7%. There was no difference in mortality between groups (I, 3.3% vs II, 3.8%). Group I patients also had similar rates of paraplegia (I, 0% vs II, 2.2%), stroke (I, 1.2% vs II ,1.1%), and renal failure (I, 1.7% vs II, 5.5%). Group I patients had significantly more recurrent nerve palsies (I, 33% vs II, 4.9%) although this did not translate into a higher incidence of respiratory failure. CONCLUSIONS: Repair of thoracic aneurysms arising in the distal arch can be repaired with a technique based on simple cross-clamping without an increase in mortality or major neurologic injury. Recurrent nerve palsy is much more common with this approach but is well-tolerated without increasing the need for tracheostomy.

publication date

  • January 1, 2005

Research

keywords

  • Aorta, Thoracic
  • Aortic Aneurysm, Abdominal
  • Aortic Aneurysm, Thoracic
  • Constriction
  • Postoperative Complications

Identity

Scopus Document Identifier

  • 11144298779

Digital Object Identifier (DOI)

  • 10.1016/j.athoracsur.2004.06.083

PubMed ID

  • 15620929

Additional Document Info

volume

  • 79

issue

  • 1