Descending thoracic aortic aneurysms: surgical treatment with the Gott shunt

Over the past 16 years, 267 consecutive patients underwent surgery for a descending thoracic aortic aneurysm. To provide optimal protection of surrounding organs during aortic occlusion, a 9-mm Gott shunt was used for distal perfusion in all cases. The shunt was placed preferentially between the ascending aorta and the descending aorta; however, alternative sites of proximal and distal cannulation were chosen according to the location and the extent of the aneurysmal disease and the presence of a concomitant aneurysm along the aortic conduit. In one-third of the patients, a flowmeter on the shunt recorded shunt flows, which varied from 1100 mL/min to 4900 mL/min (mean 2526 mL/min). Because the highest shunt flows were obtained with proximal systolic pressures lower than 140 mm Hg, nitroglycerin and nitroprussate were used routinely to improve distal perfusion by arterial vasodilation and release of proximal organs from a circulatory overload. The mean aortic cross-clamp time was 33 minutes for the entire series but was reduced to 25 minutes for the last 140 patients. The hospital death rate was 14.6% overall (12.2% if ruptured aneurysms were excluded). Of the 267 patients, 260 survived the operation and underwent clinical neurologic assessment. No paraplegia or other spinal-cord ischemic deficit occurred.