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[Surgical results in atherosclerotic distal aortic arch aneurysm]
1Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Insights
Surgical outcomes for atherosclerotic aneurysm of the distal aortic arch remain challenging. Total arch replacement via median sternotomy shows promise in reducing serious complications like cerebral emboli.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Context:
- Atherosclerotic aneurysms of the distal aortic arch present significant surgical challenges.
- Existing surgical treatments have yielded unsatisfactory results.
- This study reviews outcomes from 119 patients treated at a single institution.
Purpose:
- To analyze the surgical results for atherosclerotic aneurysm of the distal aortic arch.
- To identify factors contributing to postoperative complications and mortality.
- To propose modifications for improved surgical outcomes.
Summary:
- 119 patients (104 male, 15 female; mean age 66) underwent various reconstructions: total replacement (29), partial replacement (49), patch (34), and bypass (7).
- Approaches included median sternotomy (75), median sternotomy+left thoracotomy (9), and left thoracotomy (35), with selective cerebral perfusion used in sternotomy cases.
- Postoperative cerebral complications occurred in 16.0% (19/119), primarily due to atheromatous emboli (15/19). In-hospital mortality was 21.8% (26/119) from respiratory insufficiency, multiple organ failure, and low cardiac output syndrome.
Impact:
- Findings highlight the need for modified operative procedures to prevent complications such as intraoperative embolisms.
- Total arch replacement using median sternotomy is identified as a technique that has improved recent surgical results.
- This research aims to enhance patient survival and reduce morbidity associated with distal aortic arch aneurysms.
Abstract:
Results of surgical treatment of atherosclerotic aneurysm of the distal aortic arch, reported to date, are not satisfactory. We recently analyzed the surgical results in 119 patients with this condition who were treated at our department. There were 104 males and 15 females, ranging in age from 38 to 81 years (mean: 66 years). The arch was reconstructed by total replacement in 29 cases, partial replacement in 49 cases, patch reconstruction in 34 cases and extra-anatomic bypass in 7 cases. The lesion was approached by median sternotomy in 75 cases, median sternotomy+left thoracotomy in 9 cases and left thoracotomy in 35 cases. In cases where median sternotomy was used, selective cerebral perfusion was generally employed as an auxiliary procedure. After surgery, cerebral complications were observed in 19 cases (16.0%). In 15 of these 19 cases, postoperative cerebral damage was attributed to atheromatous emboli. Twenty-six patients (21.8%) died in the hospital. Major causes of death included respiratory insufficiency, multiple organ failure and low cardiac output syndrome. To improve surgical results for this type of aneurysm, the operative procedure needs to be modified so that these postoperative complications are prevented. Especially it is essential to prevent intraoperative embolisms of brain and coronary arteries, and a reconstruction by total arch replacement with median sternotomy has improved recent surgical results.