Stroke in surgery of the arteriosclerotic descending thoracic aortic aneurysms: influence of cross-clamping technique of the aorta.
OBJECTIVE
The risk of stroke caused by dislodgment of loose atheromatous plaque or mural emboli is increased by cross-clamping of the aorta. Some patients undergo descending thoracic aortic aneurysm repair with proximal aortic cross-clamping between the left common carotid artery and the left subclavian artery. The objective of this study was to determine the influence of proximal aortic cross-clamping in arteriosclerotic aneurysm or dissecting aneurysm repair.


METHODS
Between May 1984 and May 2003, 81 patients underwent elective surgery for distal arch or descending aortic aneurysm repair with proximal aortic cross-clamping between the left common carotid artery and the left subclavian artery. To evaluate the influence of the proximal aortic cross-clamping, patients were divided into two groups: patients who had undergone arteriosclerotic aneurysm repair (group I, n=25) and patients who had undergone dissecting aneurysm repair (group II, n=56).


RESULTS
Eight (9.9%) of the 81 patients had a stroke. Six strokes occurred in operations for arteriosclerotic aneurysm repair group I and two strokes occurred in operations for dissecting aneurysm repair group II (24 vs 3.6%; p=0.009). In-hospital mortality rates were 12% in group I and 8.9% in group II (p=0.70). Major postoperative complications included renal failure requiring hemodialysis (in 4.2% of the patients in group I and in 8.3% of the patients in group II, p=0.99) and pulmonary complication (in 20% of the patients in group I and in 16% of the patients in group II, p=0.67).


CONCLUSIONS
Cross-clamping between head vessels should be avoided if at all possible when operating on patients who have arteriosclerotic descending thoracic aneurysms.
Kawaharada
Nobuyoshi
N
Department of Thoracic and Cardiovascular Surgery, School of Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan. nobuyosh@sapmed.ac.jp
Morishita
Kiyofumi
K
Fukada
Johji
J
Hachiro
Yoshikazu
Y
Fujisawa
Yasuaki
Y
Saito
Tatsuya
T
Kurimoto
Yoshihiko
Y
Abe
Tomio
T
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001161:Arteriosclerosis / Q000601:surgery*; D003250:Constriction; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D051437:Renal Insufficiency / Q000209:etiology; D020521:Stroke / Q000209:etiology*