One-stage segmental resection of extensive thoracoabdominal aneurysms with left-sided heart bypass

The purpose of this study is to describe a technique for resection of extensive thoracoabdominal aneurysms, which the authors believe will lower morbidity and mortality rates.

In an effort to minimize the risk of spinal cord ischemia, we have used a combination of sided heart bypass (left atrium to left femoral artery) with local cooling of the intercostal and visceral arteries and segmental resection of the aneurysm. Segmental resection of the aneurysm allows perfusion of the spinal cord and abdominal viscera as the proximal anastomosis is completed and as each pair of intercostal arteries is reimplanted. An attempt is made to reimplant all pairs of intercostal arteries from T8 to L2. Before the intercostal or visceral arteries are reimplanted, that segment of aorta is cooled with cold crystalloid solution. Thus no segment of the aorta is exposed to warm ischemia for more than 30 minutes. Left-sided heart bypass allows the patient's temperature to be maintained between 35 degrees C and 37 degrees C.

We have used this technique in 23 patients with types I and II (Crawford's classification) thoracoabdominal aneurysms. Seven patients (30%) had dissections or rupture associated with their aneurysms and underwent emergency operation. One of these seven patients became paraplegic after operation, for a 4.3% incidence of paraplegia. One patient died of multiple organ failure after operation. No patient had kidney failure requiring dialysis.

We believe that our technique allows the operation to be performed in a deliberate manner with a low incidence of paraplegia and kidney failure.