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Surgical treatment for a ruptured thoracic aortic aneurysm
1Department of Surgery, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|March 10, 2001
Summary
Emergency surgery for ruptured thoracic aortic aneurysms can be successful, especially for hemodynamically unstable patients. However, rupture into the esophagus carries a high mortality risk, highlighting the need for prompt intervention.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Treatment for ruptured thoracic aortic aneurysms (rTAA) remains controversial.
- Surgical outcomes for rTAA are critical due to high mortality rates.
Purpose of the Study:
- To assess the surgical outcomes for patients with ruptured thoracic aortic aneurysms.
- To evaluate the impact of hemodynamic stability and rupture location on patient outcomes.
Main Methods:
- A retrospective review of 19 patients undergoing surgery for rTAA between 1993 and 1998.
- Patients were categorized into Group A (unstable hemodynamics) and Group B (rupture into lung/esophagus).
- Surgical approaches included anterior or lateral, with various graft placements and use of selective cerebral perfusion.
Main Results:
- The overall hospital mortality rate was 26.3% (5 out of 19 patients).
- Postoperative complications included central nervous system dysfunction, low cardiac output syndrome, respiratory failure, renal failure, and infections.
- The perioperative event-free rate was 36.8% overall, with lower rates in Group A (25%) compared to Group B (57.1%).
Conclusions:
- Prompt operative intervention is crucial for patients with unstable hemodynamics.
- Rupture into the esophagus is associated with a significantly high mortality rate.
- Emergency surgery can be a successful treatment for ruptured thoracic aortic aneurysms.