Impact of left heart bypass on the results of thoracoabdominal aortic aneurysm repair

Schepens, Marc A.A.M.; Vermeulen, F.; Morshuis, Wim J.; Dossche, Karl M.; Dongen, Eric P. van; Beek, Huub T. ter; Boezeman, Eduard H.

doi:10.1016/s0003-4975(99)00391-4

Cited by 66 publications

(30 citation statements)

References 16 publications

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“…This variable becomes both unclear and of perhaps less importance in those centers where distal aortic perfusion methods are routinely used. 22,23 Prospective recording of the intraoperative treatment of intercostal vessels has allowed us to assess the impact of intercostal vessel management. In a prior report focusing on the use of regional hypothermia for spinal cord protection, we noted a 10-fold Thoracoabdominal Aneurysm increased risk of SCI in types I/II TAA when critical intercostal vessels were oversewn.…”

Section: Discussionmentioning

confidence: 99%

“…Whether the addition of distal perfusion is an important component to lower the degree of cord ischemia via cord collateral circulation is unclear. Many surgeons have adopted this strategy, 7,8,23 and we have used this strategy selectively in patients perceived to be at the highest risk. Unfortunately, the number of patients so managed in the present study was too small to permit firm conclusions; we certainly have observed both SCI and complications specific to left heart bypass such that we employ it in highly selective fashion.…”

Section: Discussionmentioning

confidence: 99%

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Thoracoabdominal Aneurysm Repair: Results With 337 Operations Performed Over a 15-Year Interval

Cambria¹,

Clouse²,

Davison³

et al. 2002

Annals of Surgery

334

221

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ObjectiveTo review perioperative results and late survival after thoracoabdominal aneurysm repair (TAA), in particular to assess the impact over time of epidural cooling (EC) on spinal cord ischemic complications (SCI). Summary Background DataA variety of operative approaches and protective adjuncts have been used in TAA to minimize the major complications of perioperative death and SCI. There is no consensus with respect to the optimal approach. MethodsFrom January 1987 to November 2001, 337 consecutive TAA repairs were performed by a single surgeon. Clinical features included prior aortic grafts in 97 (28.8%) and emergent operation in 82 (24.6%), including rupture in 46 (13.6%) and dissection in 63 (19%). Operative management consisted of a clamp/sew technique with adjuncts in 93%. EC (since July 1993) to prevent SCI was used in 194 (57.6%) repairs. Variables associated with the end points of operative mortality and postoperative SCI were assessed with the Fisher exact test and logistic regression; late survival was estimated with the Kaplan-Meier method. ResultsOperative mortality was 8.3% and was associated with nonelective operation, intraoperative hypotension, total transfusion requirement, and the postoperative complications of paraplegia, renal failure, and pulmonary insufficiency. Postoperative renal failure and transfusion requirement were independent correlates of mortality. SCI of any severity occurred in 38 of 334 (11.4%) operative survivors, with 22/38 (6.6% of cohort) sustaining total paraplegia. EC reduced the risk of SCI in patients with types I-III TAA (10.6% vs. 19.8%, P ϭ .04). Independent correlates of SCI over the entire study interval included types I/II TAA, rupture, cross-clamp duration, sacrifice of T9 -L1 intercostal vessels, and intraoperative hypotension. Late survival rates at 2 and 5 years were 81.2 Ϯ 3% and 67.2 Ϯ 5%. ConclusionsEC has decreased the risk of SCI after TAA repair. Decreasing the substantial proportion (nearly 25%) of patients requiring nonelective operation will improve results. Late survival is equal to that after routine AAA repair, indicating that the considerable resource expenditure required for TAA repair is worthwhile.Despite advances in endoluminal grafting for isolated thoracic and infrarenal aortic aneurysm, open operation remains the only feasible treatment option for thoracoabdominal aneurysm (TAA). Since TAA extent is relatively uncommon in the spectrum of degenerative aneurysm disease, experience and clinical reports have been largely concentrated in a modest number of centers. Even in such environments, operative mortality is generally in the 10%

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thoracoabdominal Aneurysm Repair: Results With 337 Operations Performed Over a 15-Year Interval

Cambria¹,

Clouse²,

Davison³

et al. 2002

Annals of Surgery

334

221

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“…As a protection strategy, we employed a technique of left heart bypass (LHB) with mild hypothermia and distal perfusion through a femoral cannula. There are conflicting reports regarding the efficiency of this strategy [6,7]. Schepens et al found that the use of LHB reduced not only the rates of hospital mortality but also paraplegia/paraparesis and postoperative renal failure requiring dialysis [6].…”

Section: Discussionmentioning

confidence: 99%

“…There are conflicting reports regarding the efficiency of this strategy [6,7]. Schepens et al found that the use of LHB reduced not only the rates of hospital mortality but also paraplegia/paraparesis and postoperative renal failure requiring dialysis [6]. They also revealed that the rupture of TAAA increased the risk of paraplegia or paraparesis (odds ratio 3.2).…”

Section: Discussionmentioning

confidence: 99%

Unusual case of successful treatment of a ruptured thoracoabdominal aneurysm in elderly woman

Oszkinis

Perek

et al. 2016

Acta Angiologica

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“…To date, abundant experimental and clinical evidences reveal that these techniques do reduce the incidence of paraplegia compared with the simple clamp-and-sew approach. Notably, data from studies that concurrently employed distal perfusion and clamp-and-sew procedures have demonstrated that the exponential rise in paraplegia rates when clamp times exceeds 30 min with clamp-and-sew technique alone does not occur [34]. Several techniques have been advocated for the perfusion of the distal aorta, such as femoro-femoral bypass, passive shunts, and left heart bypass.…”

Section: Distal Perfusion Techniquesmentioning

confidence: 99%

Spinal Cord Protection for Descending or Thoracoabdominal Aortic Aneurysm Repair

Kawaharada¹,

Ito²,

Higami³

2011

Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms

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Impact of left heart bypass on the results of thoracoabdominal aortic aneurysm repair

Cited by 66 publications

References 16 publications

Thoracoabdominal Aneurysm Repair: Results With 337 Operations Performed Over a 15-Year Interval

Thoracoabdominal Aneurysm Repair: Results With 337 Operations Performed Over a 15-Year Interval

Unusual case of successful treatment of a ruptured thoracoabdominal aneurysm in elderly woman

Spinal Cord Protection for Descending or Thoracoabdominal Aortic Aneurysm Repair

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