Mommertz Gottfried, Langer Stephan, Koeppel Thomas A, Schurink Geert W, Mess Werner H, Jacobs Michael J
European Vascular Center Aachen - Maastricht, Maastricht, Germany; University Hospitals Aachen - Maastricht, Maastricht, Germany.
J Vasc Surg. 2009 Apr;49(4):886-92. doi: 10.1016/j.jvs.2008.11.040.
We assessed the surgical and neurological outcome of patients undergoing simultaneous repair of aortic arch and descending thoracic aortic aneurysms (DTAA) or thoracoabdominal aortic aneurysms (TAAA) via left thoracotomy or thoracolaparotomy.
During a 6-year period, we performed 32 procedures in 23 male and 9 female patients with DTAA or TAAA with concomitant aortic arch aneurysms. The mean age of the patients was 50.9 years (range, 18-75 years). Twenty-two patients suffered from DTAA, 4 had type-I TAAA, and 6 had type-II TAAA. The entire aortic arch was involved in 12 patients and the distal hemi-arch in 20 patients. The mean diameter of the aneurysms was 6 cm (range, 4.9-7.6 cm). All patients were operated on according to the protocol with cerebrospinal fluid drainage, distal aortic and selective organ perfusion, as well as antegrade brain perfusion. Neuromonitoring was performed by means of motor evoked potentials (MEPs), transcranial Doppler (TCD), and electroencephalography (EEG).
All patients survived the surgical procedure and 30-day mortality did not occur. At the end of the procedure, all patients had adequate MEPs, TCD, and EEG. One patient died 47 days after operation due to gastrointestinal bleeding and therapy-resistant coagulopathy. Major postoperative complications like paraplegia or paraparesis, renal failure, and myocardial infarction were not encountered. One patient had a stroke but neurological deficits were irrelevant. Mean preoperative creatinine level was 125 mmol/L, which peaked to a mean maximal level of 130 and returned to 92 mmol/L at discharge. Other complications included bleeding requiring surgical intervention (n = 4), arrhythmia (n = 1), pneumonia (n = 5), and respiratory distress syndrome (n = 2). At a median follow-up of 38 months, all but 1 patient was alive and free of re-intervention.
Single-stage repair of aortic arch and concomitant thoracic and thoracoabdominal aortic aneurysms via left-sided thoracotomy or thoraco-laparotomy yields excellent short- and midterm outcomes. Monitoring of cerebral and spinal cord function contributes to improved neurologic outcome.
我们评估了通过左胸切口或胸腹联合切口同时修复主动脉弓和降胸主动脉瘤（DTAA）或胸腹主动脉瘤（TAAA）患者的手术及神经学结果。
在6年期间，我们对23例男性和9例女性DTAA或TAAA合并主动脉弓瘤患者进行了32例手术。患者的平均年龄为50.9岁（范围18 - 75岁）。22例患者患有DTAA，4例患有I型TAAA，6例患有II型TAAA。12例患者累及整个主动脉弓，20例患者累及远端半弓。动脉瘤的平均直径为6 cm（范围4.9 - 7.6 cm）。所有患者均按照方案进行手术，包括脑脊液引流、远端主动脉和选择性器官灌注以及顺行性脑灌注。通过运动诱发电位（MEP）、经颅多普勒（TCD）和脑电图（EEG）进行神经监测。
所有患者均在手术中存活，未发生30天死亡率。手术结束时，所有患者的MEP、TCD和EEG均正常。1例患者术后47天因胃肠道出血和难治性凝血病死亡。未遇到诸如截瘫或轻瘫、肾衰竭和心肌梗死等主要术后并发症。1例患者发生中风，但神经功能缺损不严重。术前肌酐平均水平为125 mmol/L，最高峰值平均为130，出院时恢复至92 mmol/L。其他并发症包括需要手术干预的出血（n = 4）、心律失常（n = 1）、肺炎（n = 5）和呼吸窘迫综合征（n = 2）。在中位随访38个月时，除1例患者外，所有患者均存活且无需再次干预。
通过左侧胸切口或胸腹联合切口对主动脉弓及合并的胸主动脉和胸腹主动脉瘤进行一期修复可产生优异的短期和中期结果。对脑和脊髓功能的监测有助于改善神经学结果。
