title: [Current trends in the surgical management of thoracoabdominal aortic aneurysms].
abstract: BACKGROUND
  The authors present a group of patients, who underwent standard procedures on thoracic (TAA) and thoracoabdominal (TAAA) aortic aneurysms from 01-01-2009 to 15-09-2010.
  
  
  METHODS
  During the above time period, a total of 29 patients were operated. The authors employed as many known organ protection procedures as possible, including reduced heparinization, mild hypothermia (32-34 degrees C), sequential aortic clamping cerebrospinal drainage, left heart bypass (a biopump) with non-ischemic canylation of the femoral artery, selective visceral blood perfusion (superior mesenteric artery and coeliac trunk) and renal arteries perfusion using cold crystallic solution. For technical reasons, monitoring of somatosensory and motor evoked potentials was used only twice. In the majority of TAAA procedures, the thoracoretroperitoneal approach was used.
  
  
  RESULTS
  During the studied period, the overall mortality rate was 24%. In 2009, a total of 16 patients were operated, out of which 14 subjects underwent elective procedures. Two subjects underwent urgent procedures for ruptures and both of them died. In 2009, the mortality rate was 21% for planned procedures. In the following year, from January to September 15, a total of 13 patients underwent surgery, out of whom 11 underwent elective and two urgent procedures. The group's overall mortality rate was 15.4%, the mortality rate in elective surgery patients was 9% . One patient undergoing urgent surgery survived and one exited. Postoperative paraplegia was reported in one subject (3,4%), postoperative dialysis due to postoperative renal insufficiency was used in 6.9% and other postoperative complications occurred in 10,3% of the subjects.
  
  
  CONCLUSIONS
  Mortality and morbidity rates in the surgical management of thoracoabdominal aortic aneurysms remain considerably high, although new procedures of organ protection help to reduce it. These highly specialized procedures require a multispecialty approach and a well- coordinated surgical team, specialized in this problematics.
authors.affiliation: Oddelení cévní chirurgie, Nemocnice Na Homolce, Praha. petr.stadler@homolka.cz
authors.forename: P
authors.initials: P
authors.lastname: Stádler
authors.forename: P
authors.initials: P
authors.lastname: Zdráhal
authors.forename: P
authors.initials: P
authors.lastname: Sebesta
authors.forename: L
authors.initials: L
authors.lastname: Dvorácek
authors.forename: P
authors.initials: P
authors.lastname: Vitásek
authors.forename: M
authors.initials: M
authors.lastname: Slais
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D014656:Vascular Surgical Procedures / Q000379:methods*