Surgery for ruptured thoracic and thoraco-abdominal aortic aneurysms

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Aortic Aneurysm Repair

Background:

• Ruptured descending thoracic and thoracoabdominal aortic aneurysms present a critical surgical challenge.
• Outcomes of emergency repair for these conditions require careful evaluation against elective procedures.

Purpose of the Study:

• To compare the outcomes of emergency repair for ruptured descending thoracic and thoracoabdominal aortic aneurysms with elective surgery for chronic lesions.
• To identify predictors of mortality and complications in patients undergoing aortic aneurysm repair.

Main Methods:

• A prospective study of 100 patients undergoing descending aorta repair (segments 1-8).
• Utilized techniques including proximal unloading, distal protection, partial cardiopulmonary bypass, and low systemic heparinization.
• Staged cross-clamping, sealed grafts, and graft inclusion were employed.

Main Results:

• Arteriosclerotic lesions were prevalent in 53% of patients; dissecting lesions in 38%.
• Ruptured aneurysm patients had significantly lower preoperative hematocrit (33% vs. 40%, P < 0.001).
• Thirty-day mortality was 9% overall (6% chronic, 15% ruptured, NS). Paraparesis/plegia occurred in 9% of patients.
• Aortic cross-clamp time predicted mortality (P=0.002) and paraparesis/plegia (P=0.001).

Conclusions:

• Emergency repair of ruptured descending thoracic and thoracoabdominal aortic aneurysms is feasible with acceptable results.
• Aortic cross-clamp time is a critical factor influencing outcomes, highlighting the need for efficient surgical techniques.