Article

Single-stage repair of extended thoracic aortic aneurysm.

Second Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo City, Yamanashi, Japan.
Interactive Cardiovascular and Thoracic Surgery (Impact Factor: 1.11). 01/2009; 8(3):377-8. DOI: 10.1510/icvts.2008.190801
Source: PubMed

ABSTRACT We report the case of a 78-year-old man with an extended thoracic aortic aneurysm in whom replacement of the ascending aorta, aortic arch, and descending aorta were performed by single-stage repair. Single-stage repair surgical approach in this case was selected rather than two-stage repair because of the risk of rupture of the aneurysm in the period before the second surgery and the patient's somewhat unstable mental condition that could have reduced his motivation for a second surgery. At surgery, replacement of descending aorta was performed with thoracotomy in a right semisupine position, and replacement of ascending aorta and aortic arch was performed with a median sternotomy in the supine position by changing the position of the left forearm. The postoperative course was smooth without major complications. This case illustrates that the choice of surgical procedure should be made based on the shape of the aortic aneurysm and the mental and general conditions of the patient.

0 Bookmarks
 · 
53 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Aneurysms of the ascending, arch, and descending thoracic aorta are typically managed with two operations. The first stage involves replacement of the ascending and arch aorta leaving a segment of graft in the proximal descending aorta with a mortality and stroke risk of 8%. The second stage involves replacement of the descending aorta with a mortality of 5% and a paraplegia risk of 5% to 10%. Some patients refuse surgical completion and others are at increased risk to undergo the second stage thoracotomy, leaving them with untreated descending thoracic aortic aneurysms vulnerable to rupture. A single-stage transmediastinal operation used in 14 patients is described.Methods. Under circulatory arrest, the descending thoracic aorta is opened. A wire is passed up to the arch and a graft is brought down and secured excluding the descending thoracic aneurysm. The arch vessels are attached as a single patch and the graft is brought forward, replacing the ascending aorta.Results. Fourteen patients have undergone single-stage replacement of the ascending, arch, and descending aorta with a 14% mortality rate and 14% incidence of paraplegia.Conclusions. Patients with aneurysms of the ascending, arch, and descending thoracic aorta can be managed with a single operation with comparable mortality and morbidity of the two-stage approach.
    The Annals of Thoracic Surgery 11/2001; · 3.45 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The goal of total aortic resection surgery is to correct the extensive or multiple sites of aortic pathology, which involves the entire length of the vessel. This study describes our experience in this operation at Fuwai Cardiovascular Hospital. From February 2004 to October 2005, thirteen patients with Marfan syndrome underwent one-stage total or subtotal aortic replacement for aortic dissection or aortic aneurysms. Four patients received subtotal aortic replacement (ascending aorta to the abdominal aorta). Nine patients underwent total aortic replacement (ascending aorta to the aortic bifurcation). Operations were performed under circulatory arrest with profound hypothermia. Patients were opened with a mid-sternotomy and a thoracoabdominal incision. Extracorporeal circulation was instituted with two arterial cannulae and a single venous cannula in the right atrium. During cooling, the ascending aorta or aortic root was replaced. At the nasopharyngeal temperature of 20 degrees C, the aortic arch was replaced with selective antegrade cerebral perfusion. After brain reperfusion, staged aortic occlusions allowed for replacement of descending thoracic and abdominal aorta. Intercostal, visceral, and renal arteries were anastomosed to the graft. There was no operative or early postoperative death. One case of postoperative complication was noted for cerebral infarction secondary to embolism. Spinal neurologic deficits did not occur. At the last follow-up, ranging from 4 to 24 months postoperatively, all 13 patients were alive and had good functional status. One-stage total or subtotal aortic replacement for treatment of extensive aortic disease is feasible with acceptable surgical risks and satisfactory results. It can eliminate the risk of remnant aortic aneurysm rupture in staged total aortic replacement.
    The Annals of thoracic surgery 09/2006; 82(2):542-6. · 3.45 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aneurysms of the aortic arch seldom occur alone. They usually involve the ascending aorta. Occasionally, the aneurysm also involves the descending thoracic or thoracoabdominal aorta. We advocate a staged approach for repair of these extensive aortic aneurysms, with the ascending and arch generally being repaired in the first stage and the descending thoracic or thoracoabdominal aorta being repaired in the second stage. Between February 1991 and December 2005, we repaired aneurysms of the ascending, arch, descending thoracic, and thoracoabdominal aorta in 2120 patients. Of these, 254 (12.0%) involved the ascending, arch, and descending aorta (extensive aortic aneurysm). A first-stage repair was done in 254 patients, and 115 returned for a second-stage repair for a total of 369 procedures performed. First-stage 30-day mortality was 6.3% (16/254), with the glomerular filtration rate (GFR) exceeding 70 mL/min in 2.9% of patients and less than 70 mL/min in 10.5% (p < 0.03). Second-stage 30-day mortality was 9.6% (11/115), with GFR exceeding 70 mL/min in 4.9% and less than 70 mL/min in 9.8% (not significant). The incidence of postoperative stroke for the first stage was 2.0% (5/254), and the rate of neurologic deficit (paraplegia and paraparesis) was .9% (1/115) in the second stage. The mortality for the interval of 31 days to 6 weeks after the first-stage operation was 2.9% (7/238). Aneurysms involving the transverse arch with extensive involvement of the ascending and descending thoracic or thoracoabdominal aorta can be effectively repaired using the two-stage technique with acceptable morbidity and mortality. GFR correlates to surgical outcome in the first-stage repair. After the first stage, prompt treatment of the remaining segment of aorta is crucial to success.
    The Annals of thoracic surgery 02/2007; 83(2):S815-8; discussion S824-31. · 3.45 Impact Factor

Full-text

View
0 Downloads