[Aneurysms of the aortic arch. Experience of 19 cases]

From 1980 to 1990, 19 consecutive patients were operated for chronic aneurysm of the aortic arch: 16 men and 3 women with a mean age of 46 years (range: 20 to 72 years). Four aneurysms were proximal, with a distal limit in the left common carotid artery; 4 were distal, starting beyond the brachiocephalic trunk and 11 involved the entire aortic arch. Three were atheromatous, 9 were dystrophic, 1 was syphilitic, 1 was post-traumatic, 1 was secondary to coarctation and 4 was secondary to longstanding dissection. Four cases (21%) were in a state of pre-rupture. They were all operated under cardiopulmonary bypass with profound hypothermia and circulatory arrest in 11 cases (9 cases of aneurysm involving the entire segment II and two cases of distal aneurysms). Selective cannulation of the large cervical arteries supplying the brain was performed in 5 cases (3 cases of proximal aneurysms and 2 cases of aneurysms of the entire segment II). Seven patients simultaneously underwent aortic valve replacement and replacement of the ascending aorta. One patient underwent replacement of the descending aorta and another underwent an ascending aorta-supracoeliac aorta bypass graft. The early mortality was 10.5% (2 patients out of 19) and the late mortality was 5.8% (1 patient out of 17). The mean follow-up was 46 months (maximum: 9 years, minimum: 9 months), and the 9-year actuarial survival rate was 86%. This study demonstrated the superiority of selective carotid cannulation as a means of cerebral protection.