Thoracic and thoracoabdominal aortic aneurysm repair using cardiopulmonary bypass, profound hypothermia, and circulatory arrest via left side of the chest incision

Safi, Hazim J.; Miller, Charles C.; Subramaniam, Mahesh H.; Campbell, Matthew; Iliopoulos, Dimitrios; O’Donnell, John J.; Reardon, Michael J.; Letsou, George V.; Espada, Rafael

doi:10.1016/s0741-5214(98)70081-3

Cited by 124 publications

(76 citation statements)

References 11 publications

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“…An audit of cardiothoracic units in Great Britain and Ireland showed a mortality rate of 28 per cent for procedures involving the descending thoracic aorta and 25 per cent for procedures treated without bypass 13 . There is a large discrepancy between these data and published series from the USA, in which mortality rates range from 8 to 10 per cent 14,15 . The incidence of postoperative complications following open surgery for thoracic aortic disease is high.…”

Section: Discussioncontrasting

confidence: 56%

Mid-term results for second-generation thoracic stent grafts

Bell

Taylor

Aukett

et al. 2003

British Journal of Surgery

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Section: Discussioncontrasting

confidence: 56%

Mid-term results for second-generation thoracic stent grafts

Bell

Taylor

Aukett

et al. 2003

British Journal of Surgery

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“…6 -10 Although the protective properties of hypothermia are well documented in surgery of the ascending aorta and transverse aortic arch, the drawbacks of lowering systemic temperature are also well known. 11 Although the ascending aorta, aortic arch, and proximal descending aorta can be reached through a single thoracotomy incision, 12 the number of incisions and consequent risk is increased if surgery requires aortic or mitral valve replacement and/or coronary artery bypass. 13 In 1992, brain protection in the first stage of the elephant trunk technique was enhanced by the introduction of retrograde cerebral perfusion.…”

Section: Discussionmentioning

confidence: 99%

Staged Repair of Extensive Aortic Aneurysms

et al. 2001

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Background-Extensive aortic aneurysms (ascending aorta, aortic arch, and descending or thoracoabdominal aorta) require innovative surgical techniques. Some surgeons advocate a single procedure with long periods of profound hypothermia, whereas others use a staged approach. We adopted a two-staged procedure (elephant trunk technique) in 1991 for elective repair of extensive aortic aneurysms. Methods and Results-Between February 1991 and May 2000, we performed a total of 1146 aortic aneurysm operations.Of these, 182 (15.9%) operations were first-or second-stage elephant trunk procedures, performed in a total of 117 patients. Stage 1 was completed in all 117 patients. Stage 2 was completed in 65 (55.6%) of 117 patients. Thirty-day mortality rate for the first stage was 5.1% (6 of 117). Mortality rate during the interval between operations was 3.6% (4 of 111), of which 75% (3of 4) were the result of aneurysm rupture. Thirty-day mortality rate for the second stage was 6.2% (4 of 65). A total of 43 patients did not return for second-stage repair. Among these patients, within an average period of 3.4 years (range, 1.5 months to 4.9 years), 13 of 43 (30.2%) died, 4 of 13 (30.8%) as the result of rupture. Two of 117 (1.7%) first-stage patients had postoperative stroke. No spinal cord dysfunction occurred in second-stage patients. Conclusions-Extensive aortic aneurysms can be repaired with acceptable morbidity and mortality rates through the use of the elephant trunk technique. Death was most commonly the result of rupture, both in interval patients awaiting scheduled second-stage repair and in patients who did not return. After the first stage, prompt treatment of the remaining segment is crucial to the success of staged repair.

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“…33 However, because of the bleeding and pulmonary complications that often accompany this technique, most surgeons believe that it should be utilized when no other technical option exists for repair of TA/TAA. 34 Such circumstances are, in fact, rare in our experience. The 2 most commonly applied approaches involve a clamp-and-sew technique, usually supplemented by protective adjuncts, versus the use of distal aortic perfusion usually provided as an atriofemoral bypass circuit.…”

Section: Open Surgical Repairmentioning

confidence: 59%