Schepens M, Vermeulen F
Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Acta Chir Belg. 1998 Oct;98(5):207-11.
To evaluate the influence of the use of a bypass on the results of thoracoabdominal aortic aneurysm surgery.
The results of the repair of 224 thoracoabdominal aortic aneurysms operated upon between 1981 and the end of 1996 were evaluated retrospectively. In 122 cases we used simple cross-clamping (clamp and sew technique) and in 102 cases a left heart bypass (atrio-femoral or aorto-femoral) was the preferred method. Except for the use of cerebrospinal fluid drainage over the last years, the methods of spinal protection were the same in both groups. Renal protection was also identical in both groups. All aneurysms were repaired using the inlay technique.
Hospital mortality was 11.2%: 14.7% in cross-clamp group versus 6.8% in the bypass group (p = 0.04). Postoperative dialysis was necessary in 9.8%: 12.7% in the cross-clamp group versus 6.8% in the bypass group (p = 0.108). Paraplegia occurred in 8.4%: 7.4% in the cross-clamp group versus 9.8% in the bypass group (p = 0.517). Using the highly predictive model of Acher, there would have been 33% spinal cord lesions in the bypass group.
Hospital mortality, postoperative dialysis and postoperative spinal cord problems are lowered by the use of a bypass during the repair of thoracoabdominal aortic aneurysms. These results evidence that the use of a bypass is indicated in this complex operation.
