Ruptured descending and thoracoabdominal aortic aneurysms.
BACKGROUND
Advances in end-organ protection have dramatically reduced the incidence of the life-threatening complications associated with the elective repair of thoracoabdominal and descending thoracic aortic aneurysms. However, in the setting of a ruptured thoracic aneurysm, one may not have the luxury of complex end-organ support. We analyzed our experience with ruptured thoracic aneurysms to define morbidity and mortality in the present era.


METHODS
One hundred seventy-two patients with thoracoabdominal or descending thoracic aneurysms were operated on between July 1997 and October 2001. Forty presented with either a contained or free rupture. Three techniques were used for aortic reconstruction: clamp and sew, left heart bypass, and hypothermic circulatory arrest. Adjuncts for neurologic and renal support were used when circumstances and anatomy permitted.


RESULTS
Seven of 40 patients died in the hospital (17.5%). Four patients died intraoperatively, all of acute myocardial infarction. Five of the seven deaths were in patients who presented in shock. Two patients (5%) experienced paraplegia, 3 (7.5%) had renal failure requiring hemodialysis, 8 (20%) required a tracheostomy, and 6 (15%) had recurrent nerve palsies. There was one stroke (2.6%). Mean diameter of ruptured aneurysms was 8.5 cm.


CONCLUSIONS
Ruptured thoracic aneurysms can be repaired with a gratifying rate of salvage. Rapid diagnosis and triage for repair is necessary to avoid progressive deterioration into shock. The incidence of myocardial infarction, and the mortality associated with this event, underscores the need for aggressive cardiac evaluation in the elective thoracic aneurysm patient. The size at rupture also emphasizes the need for earlier referral for elective aneurysm repair.
Girardi
Leonard N
LN
Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, New York, New York, USA. lngirard@mail.med.cornell.edu
Krieger
Karl H
KH
Altorki
Nasser K
NK
Mack
Charles A
CA
Lee
Leonard Y
LY
Isom
O Wayne
OW
D000328:Adult; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003663:Decision Trees; D005227:Fatty Acids; D006801:Humans; D008875:Middle Aged; D013395:Sucrose / Q000031:analogs & derivatives*
D005227:Fatty Acids; D013395:Sucrose; C013692:sucrose polyester