Clarian Cardiovascular Surgeons, Methodist Hospital, Indianapolis, IN, USA.
J Thorac Cardiovasc Surg. 2010 Dec;140(6 Suppl):S154-60; discussion S185-S190. doi: 10.1016/j.jtcvs.2010.08.054.
Open repair of descending thoracic aortic and thoracoabdominal aortic aneurysms may carry low morbidity and mortality, depending on experience of the surgeon and operative technique used. Although thoracic endovascular aortic repair is less invasive, its limitations include anatomy and pathology of the aorta, proximity of major branches, and significant complication and reintervention rates. We retrospectively reviewed a 2-surgeon experience (J.W.F. and J.S.C.) with deep hypothermic circulatory arrest to repair descending thoracic aortic and thoracoabdominal aortic aneurysms.
All patients (n = 343) who underwent surgical replacement of descending thoracic aortic or thoracoabdominal aortic aneurysm with deep hypothermic circulatory arrest from 1995 to 2009 were included. Segmental arteries between T8 and the celiac artery were aggressively reimplanted as indicated. Visceral and renal artery bypasses were performed for significant stenosis. Concomitant coronary artery bypass grafting was performed if targets were anterior or lateral wall vessels. Lumbar drains were not routinely used but placed postoperatively on clinical evidence of spinal cord ischemia.
Of 343 patients, 98 had descending thoracic aortic aneurysms, 69 had Crawford type I thoracoabdominal aortic aneurysms, 111 had type II, 32 had type III, and 33 had type IV. Emergency or urgent operations comprised 13% of repairs. Hospital mortalities were 5.0% for all cases, 3.7% for elective cases, and 13.3% for urgent or emergency cases. Overall incidences were 4.4% for stroke, 3.2% for paraplegia or paraparesis, 1.5% for renal failure requiring dialysis, and 3.5% for tracheostomy. The 1-, 3-, 5-, and 10-year survival rates were 90%, 79%, 69%, and 54%, respectively.
Surgical repair of descending thoracic aortic and thoracoabdominal aortic aneurysms with deep hypothermic circulatory arrest carries low operative morbidity and mortality and excellent early and late survival rates. These results can be used as a benchmark for future techniques and technologies.
降胸主动脉和胸腹主动脉瘤的开放修复术的发病率和死亡率较低，具体取决于外科医生的经验和手术技术。虽然胸主动脉腔内修复术的创伤较小，但它也有一定的局限性，包括主动脉的解剖结构和病理学、主要分支的位置以及较高的并发症和再干预率。我们回顾性分析了两位外科医生（J.W.F. 和 J.S.C.）应用深低温停循环技术修复降胸主动脉和胸腹主动脉瘤的经验。
纳入了 1995 年至 2009 年间接受深低温停循环下手术治疗降胸主动脉或胸腹主动脉瘤的 343 例患者。根据需要积极重建 T8 与腹腔干之间的节段性动脉。对于明显狭窄的内脏和肾动脉旁路移植术。如果目标是前壁或侧壁血管，同期进行冠状动脉旁路移植术。常规不使用腰大池引流，但在出现脊髓缺血的临床证据时术后放置。
343 例患者中，98 例为降胸主动脉瘤，69 例为 Crawford Ⅰ型胸腹主动脉瘤，111 例为Ⅱ型，32 例为Ⅲ型，33 例为Ⅳ型。急诊或紧急手术占所有手术的 13%。全组住院死亡率为 5.0%，择期手术为 3.7%，急诊或紧急手术为 13.3%。总的卒中发生率为 4.4%，截瘫或不全瘫为 3.2%，需要透析的肾衰竭为 1.5%，气管切开术为 3.5%。1、3、5、10 年生存率分别为 90%、79%、69%和 54%。
深低温停循环下手术治疗降胸主动脉和胸腹主动脉瘤的手术发病率和死亡率较低，早期和晚期生存率均较高。这些结果可作为未来技术和技术的基准。
