Surgery for ruptured thoracic and thoraco-abdominal aortic aneurysms.

Details

Serval ID
serval:BIB_13B505B85623
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Surgery for ruptured thoracic and thoraco-abdominal aortic aneurysms.
Journal
European Journal of Cardio-Thoracic Surgery
Author(s)
von Segesser L.K., Genoni M., Künzli A., Lachat M., Niederhäuser U., Vogt P., Schönbeck M., Turina M.
ISSN
1010-7940
Publication state
Published
Issued date
1996
Peer-reviewed
Oui
Volume
10
Number
11
Pages
996-1001; discussion 1002
Language
english
Notes
Publication types: Comparative Study ; Journal Article - Publication Status: ppublish
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.
Keywords
Aneurysm, Dissecting, Aortic Aneurysm, Abdominal, Aortic Aneurysm, Thoracic, Aortic Rupture, Arteriosclerosis, Chronic Disease, Emergencies, Erythrocyte Transfusion, Hematocrit, Humans, Methods, Middle Aged, Paraplegia, Postoperative Complications, Prospective Studies, Surgical Procedures, Elective, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
14/02/2008 14:19
Last modification date
20/08/2019 12:42
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