Surgery for ruptured thoracic and thoraco-abdominal aortic aneurysms

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Abstract

Objective. To assess the outcome of patients with ruptured descending thoracic and thoracoabdominal aortic aneurysms undergoing emergency repair, in comparison to elective surgery for chronic lesions. Methods. A prospective study of 100 consecutive patients operated upon the descending aorta (1-8 segments) using proximal unloading and distal protection with partial cardiopulmonary bypass, heparin surface-coated perfusion equipment and low systemic heparinization (loading dose 100 IU/kg, activated coagulation time >180 s), staged cross-clamping, sealed grafts and graft inclusion. Results. Arteriosclerotic lesions were present in 53/100 patients (53%) for all, 30/53 (56%) for chronic, and 21/33 (63%) for ruptured, aneurysms (NS). Dissecting lesions were found in 38/100 patients (38%) for all, 20/53 (38%) for chronic, and 8/33 (24%) for ruptured aneurysms (NS). Preoperative hematocrit was 38 ± 6% for all, 40 ± 5% for chronic, and 33 ± 5% for ruptured aneurysmal patients (P < 0.001 ruptured versus chronic). The extent of aortic repair (1-8 segments) was 3.3 ± 1.6 for all, 3.5 ± 1.5 for chronic, and 3.2 ± 1.4 for ruptured, aneurysms (NS). Transdiaphragmatic repair was performed in 51/100 (51%) of all, 28/53 (53%) of chronic, and 17/33 (51%) of ruptured aneurysms (NS). Aortic cross-clamp time was 38 ± 21 min for all, 39 ± 24 min for chronic, and 38 ± 17 min for ruptured, aneurysmal patients (NS). The amount of red cells washed and autotransfused was 2792 ± 2239 ml in all, 3143 ± 2531 ml in chronic, and 2074 ± 1350 ml in ruptured, aneurysmal patients (P < 0.025). The amount of packed red cells required was 2181 ± 1830 ml for all, 1736 ± 1333 ml for chronic, and 2947 ± 2395 ml for ruptured aneurysmal patients (P < 0.010). Thirty-day mortality was 9/100 (9%) for all, 3/53 (6%) for chronic, and 5/33 (15%) for ruptured aneurysmal patients (NS). Parapareses/plegias occurred in 9/100 (9%) of all, 6/53 (11%) of chronic, and 3/33 (9%) of ruptured, aneurysmal patients (NS). Stepwise regression analysis identified aortic cross-clamp time as a predictor of early mortality (P = 0.002) and parapareses and paraplegias (P = 0.001). Age (P = 0.001), extent of repair (P = 0.008) and preoperative hematocrit (P = 0.001) were predictors for homologous transfusion requirements. Conclusion. Emergency repair of ruptured descending thoracic and thoracoabdominal aortic aneurysms can be achieved with acceptable results. © Springer-Verlag 1996.

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Von Segesser, L. K., Genoni, M., Künzli, A., Lachat, M., Niederhäuser, U., Vogt, P., … Turina, M. (1996). Surgery for ruptured thoracic and thoraco-abdominal aortic aneurysms. European Journal of Cardio-Thoracic Surgery, 10(11), 996–1002. https://doi.org/10.1016/S1010-7940(96)80403-9

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