[Surgical treatment of descending thoracic aortic aneurysm with simple aortic cross-clamping versus left heart bypass using centrifugal pump].
Surgical treatment has been employed in 52 patients (pts) with descending thoracic aortic aneurysm (DS-TAA). Based on the adjuncts during aneurysmal repair, the series is divided into 2 groups; simple aortic cross-clamping was utilized to manage the lesion in group SC (n = 42), while left heart bypass using a centrifugal pump was employed during the period of aortic occlusion in LHB group (n = 10). Of these 52 pts, 4 died in hospital (group SC:2, group LHB:2). The most common complication was the respiratory failure following the renal failure. No paraplegia occurred in both groups. Biochemistric measurements of alanine aminotransferase, creatinine (CRN) and amylase (AMY) showed no difference between group SC and group LHB. In pts of SC group with normal renal function, post-operative maximum (post Max) CRN during the first month had a logarithmic correlation with total aortic cross-clamp time (TAXT). The post Max CRN of LHB group with normal renal function remained less than 3.0 mg/dl even in the case with TAXT over 60 minutes. There is also a linear correlation of post Max AMY in pts of SC group. Late survival at 4 years, including hospital death, were 83% in SC group and 63% in LHB group. We conclude that DS-TAA cases with TAXT of less than 30 min with good distal organ function can be managed with simple aortic cross-clamping; otherwise usage of LHB was recommended to support distal circulation.
Imagawa
H
H
Department of Cardiovascular Surgery, Osaka Prefectural Hospital, Japan.
Adachi
S
S
Kaneko
M
M
Ohtani
M
M
Takano
H
H
Katoh
M
M
Ueda
T
T
Bai
H Z
HZ
Yoshioka
Y
Y
Ohnishi
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003250:Constriction; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged