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Published on: August 11, 2015
Single-clamp technique for aneurysms of the descending thoracic aorta: report of 132 consecutive cases
D A Cooley1, A Golino, O H Frazier
1Texas Heart Institute at St. Luke's Episcopal Hospital, P.O. Box 20345, MC 3-258, Houston, TX 77225-0345, USA.
Insights
This study found that a single-clamp technique for descending thoracic aorta aneurysm repair is effective, with an acceptable complication rate. Keeping cross-clamp time under 30 minutes is crucial for optimal outcomes in aortic aneurysm surgery.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Aneurysms of the descending thoracic aorta require surgical repair.
- Minimizing spinal cord ischemia during these repairs is a critical challenge.
- The single-clamp technique is a proposed method to address this challenge.
Purpose of the Study:
- To evaluate the efficacy of a single-clamp technique in preventing spinal cord ischemia during descending thoracic aorta aneurysm repair.
- To assess the complication and mortality rates associated with this technique.
Main Methods:
- A retrospective review of 132 patients undergoing descending thoracic aorta aneurysm repair using a single-clamp technique with temporary partial distal exsanguination.
- Dacron graft replacement of the diseased aortic segment.
- Blood re-infusion via an auto-transfusion device.
Main Results:
- The average aortic cross-clamp time was 26.4 minutes. Patients experiencing spinal cord complications had an average cross-clamp time of 37.4 minutes.
- Overall mortality within 30 days was 12.9%.
- Spinal cord dysfunction occurred in 8.3% of patients, with paraplegia in 3.8%. Renal failure occurred in 6.8%.
Conclusions:
- The single-clamp technique offers an acceptable complication rate for descending thoracic aorta aneurysm repair.
- Mortality associated with this technique is comparable to more complex methods.
- Maintaining aortic cross-clamp times below 30 minutes is recommended for satisfactory outcomes.
Objective:
To determine the efficacy of a single-clamp technique in preventing spinal cord ischemia during repair of aneurysms of the descending thoracic aorta.
Patients And Methods:
From January 1989 to May 1999, 132 consecutive patients (91 men and 41 women, aged 31-86 years), with aneurysms of the descending thoracic aorta underwent repair using a single-clamp technique and temporary partial distal exsanguination. The diseased aortic segment was replaced with a Dacron graft. Blood was re-infused from an auto-transfusion device, and the segmental vessels were over-sewn but not implanted into the graft.
Results:
The average aortic cross-clamp time was 26.4 min (range, 11-67 min) for the overall group and 37.4 min for patients who had spinal cord complications. An average of 2066 ml of blood was auto-transfused (range, 450-6100 ml). During the first 30 postoperative days, 17 patients (12.9 %) died. Eleven patients (8.3%) had spinal cord dysfunction, six patients (4.5%) had lower-extremity paraparesis, and five patients (3.8%) had paraplegia. Nine patients (6.8%) had renal failure necessitating hemodialysis. Other complications included bleeding in 15 cases (11.4%), respiratory failure in 12 cases (9.1%), wound-related sequelae in five cases (3.8%), distal embolism in five cases (3.8%), and bowel ischemia in two cases (1.5%).
Conclusion:
The single-clamp technique yielded an acceptable complication rate, and the mortality was comparable to that seen after the use of more complex methods. For satisfactory results, the cross-clamp time should not exceed 30 min.
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