Repair for aneurysms of the entire descending thoracic aorta or thoracoabdominal aorta using a deep hypothermia

Abstract

Objective: Replacement of the entire descending aorta or of the thoracoabdominal aorta still has a significant risk for postoperative paraplegia. Surgical strategies using a deep hypothermia to protect the spinal cord or viscera are discussed.

Methods: From April 1994, 25 patients underwent graft replacement of the entire descending aorta (13 patients) or thoracoabdominal aorta (12 patients) using a deep hypothermia. Five patients had atherosclerotic aneurysms and 20 had aortic dissection. There were 20 males and 5 females, whose age ranged from 26 to 72 years old, 47 years old in average. Surgery consisted with proximal anastomosis using deep hypothermia (18 degrees C) with retrograde cerebral perfusion by elevating central venous pressure to 20 mmHg, reconstruction of the intercostal arteries, and distal open anastomosis, while perfusing the brain and heart. Proximal open anastomosis was used with retrograde cerebral perfusion technique in 18 patients. Averaged number of reconstructed intercostal arteries was 2.1 for each patient.

Results: No early mortality was found and one patient died of respiratory failure 6 months after surgery. One patient had a postoperative stroke and one had a delayed onset of paraplegia 2 days after operation. The cause of paraplegia was secondary hypoxemia and hypotension due to pneumonia.

Conclusion: Utilization of the deep hypothermia in surgery for aneurysms of the entire descending aorta or of the thoracoabdominal aorta provided an adequate protection of the spinal cord as well as the abdominal viscera, eliminated clamp injury or cerebral embolization of debris or thrombi, and afforded excellent surgical exposures.