[Evolution of the surgical repair of thoracoabdominal aortic aneurysm].
BACKGROUND
Thoracoabdominal aortic aneurysm repair requires complex surgery. Clamping of the descending aorta during the operation results in organ malperfusion, ischemia, and in some cases, irreversible end-organ damage and death. Several methods for organ preservation during the operation evolved, resulting in decreased post-operative organ malfunction. Re-attachment of intercostal arteries, cerebrospinal fluid drainage, and temporary bypass of the clamped aorta and selective perfusion of the spinal cord, intestine, liver and kidneys are widely used during the operation.


OBJECTIVE
To determine the impact of implementation of protective measures on the outcome of thoracoabdominal surgery over a decade.


METHODS
Between March 1993 and March 2003, 11 patients (age 41-80 years, average 60 years) underwent thoracoabdominal aortic aneurysm repair in our hospital. Different methods for organ preservation were used during the operation.


RESULTS
The early survival is 91%. One patient suffered from paraplegia and one from mild temporary paraparesis. Two patients died during the follow-up period (at 5 months from pneumonia and at 2 years from aortic arch rupture).


CONCLUSIONS
Implementation of all adjuncts to protect the organs dependent on aortic perfusion may eliminate the ischemic consequences of aortic clamping.
Korach
Amit
A
Department of Cardiothoracic Surgery, Hebrew University Hadassah Medical Center, Jerusalem, Israel.
Rudis
Ehud
E
Anner
Haim
H
Akopnik
Ina
I
Landesberg
Giora
G
Berlatzky
Yacov
Y
Elami
Amir
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D013903:Thoracic Surgery / Q000379:methods / Q000639:trends