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Thoracoabdominal aortic aneurysm repair: how I do it
1Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston 02114, USA.
Cardiovascular Surgery (London, England)
|October 16, 1999
Summary
This study presents a simplified surgical approach for thoracoabdominal aortic aneurysms (TAA) without circulatory assist. The technique achieved an 8% mortality and 7% paraparesis rate in over 200 patients.
Area of Science:
- Cardiovascular Surgery
- Aortic Aneurysm Research
Background:
- No consensus exists on the optimal surgical management of thoracoabdominal aortic aneurysms (TAA).
- Traditional TAA repair often involves complex techniques like circulatory assist and anticoagulation.
Purpose of the Study:
- To present a simplified, effective surgical strategy for TAA management.
- To evaluate the outcomes of this technique in a large patient cohort.
Main Methods:
- A clamp/sew technique without circulatory assist or systemic hypothermia.
- Adjuncts used include epidural cooling for spinal cord protection, regional renal hypothermia, and in-line mesenteric shunting.
- The study analyzed data from over 200 TAA patients treated over a decade.
Main Results:
- Perioperative mortality was 8% across the entire cohort.
- Paraparesis or paraplegia occurred in 7% of patients.
- Outcomes were significantly better in elective cases, with halved mortality and morbidity rates.
Conclusions:
- A simplified surgical approach for TAA is feasible and effective.
- The described technique, utilizing specific adjuncts, offers acceptable perioperative outcomes.
- Elective repair is associated with substantially improved results compared to emergency settings.