Surgical correction of descending thoracic aortic aneurysms with shunt or bypass techniques versus simple aortic cross-clamping

Abstract

Between June, 1972, and January, 1986, 57 patients underwent resection of a descending thoracic aortic aneurysm using a shunt or bypass for distal aortic perfusion (group I, n = 29) or simple aortic cross-clamping, routinely used since mid-1983 (group II, n = 28). There was a statistically significant difference in the mean age of the patients: in group II it was 14 years higher than in group I (group I: 52.8 years, group II: 66.5 years). Of these 57 patients, 8 died in hospital (group I: 6 patients, group II: 2 patients). Hospital mortality was strongly related to preoperative rupture and the incidence of intraoperative complications. Postoperative paraplegia occurred in 3 patients, all in group I, and could be related to ligation of four or more intercostal arteries between T8 and T12. Postoperative renal failure, necessitating dialysis in 5 patients, was strongly related to intraoperative hypotension, and also to emergency procedures and pre-existing renal dysfunction. Intraoperative haemorrhage occurred more often using shunting or bypass techniques. Mortality, paraplegia and renal failure showed a decreasing trend after abandoning the use of adjunctive perfusion.