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Is clamp and sew still viable for thoracic aortic resection?
M C Mauney1, C G Tribble, J T Cope
1Department of Surgery, University of Virginia School of Medicine, Charlottesville 22908, USA.
Annals of Surgery
|May 1, 1996
Summary
The clamp-and-sew technique for descending thoracic and thoracoabdominal aortic resection is viable, with most procedures completed under 40 minutes. However, spinal cord injury risk persists, necessitating improved protection strategies.
Area of Science:
- Cardiovascular Surgery
- Aortic Surgery
- Thoracic Surgery
Background:
- Paraplegia is a significant risk after thoracoabdominal aortic resection.
- The clamp-and-sew technique is favored for its simplicity in specific cases.
- Spinal cord protection strategies are crucial but imperfect.
Purpose of the Study:
- To review the morbidity and mortality associated with the clamp-and-sew technique for descending thoracic and thoracoabdominal aortic resection.
- To evaluate the incidence of spinal cord injury in patients undergoing this procedure.
Main Methods:
- Retrospective review of 91 consecutive patients undergoing thoracic aortic resection.
- Analysis of clamp-and-sew technique without additional spinal cord protection adjuncts.
- Data collection on patient demographics, mortality, and neurological outcomes.
Main Results:
- In-hospital mortality was 13%; 9.9% incidence of postoperative spinal cord injury (paraparesis/paraplegia).
- Most repairs (89%) were completed within 40 minutes of aortic occlusion.
- No significant difference in cross-clamp times between patients with and without neurological injury.
Conclusions:
- The clamp-and-sew technique remains a viable option for thoracoabdominal aortic resection.
- Spinal cord protection during aortic occlusion requires further development, as injury can occur even with short clamp times.
- Development of reproducible, safe, and simple spinal cord protection methods is essential.