摘要
Staged procedures for extensive aneurysmal disease of the thoracic aorta are a ssociated with a substantial cumulativemortality(20%) that includes hospitalmor tality for the 2 procedures and death(often from aortic rupture) in the interval between the 2 procedures. We have used a single-stage technique for operative repair of most or all of the thoracic aorta. Forty-six patients with extensive disease of the thoracic aorta were managed with a single-stage procedure by usi ng a bilateral anterior thoracotomy and transverse sternotomy, hypothermic circu latory arrest, and reperfusion of the aortic arch vessels first to minimize brai n ischemia. Thirty-one patients with chronic, expanding type A aortic dissectio ns had previous operations for acute type A dissection(n=22), aortic valve repai r or replacement (n=4), coronary artery bypass grafting(n=4), or no previous ope ration(n=1). The remaining 15 patients had degenerative aneurysms(n=12) or chron ic type B dissections with proximal extension(n=3). The ascending aorta and aort ic arch were replaced in all patients combined with resection of various lengths of descending aorta(proximal one third[n=19], proximal two thirds to three quar ters [n=22], or all [n=5]). Coronary artery bypass grafting, valve replacement, or both were performed concomitantly in 19 patients. Hospital mortality was 6.5 %(3 patients). Morbidity included reoperation for bleeding(17%), mechanical ve ntilation for more than 72 hours(42%), temporary tracheostomy(13%), and tempor ary renal dialysis (9%). No patient sustained a stroke. There have been 5 late deaths(3, 18, 34, 51, and 79 months postoperatively) unrelated to the aortic dis ease. Four patients have undergone successful reoperation on the aorta(false ane urysm[n=1], endocarditis[n=1], and progression of disease [n=2]). Five-year sur vivalwas 75%. The single-stage, arch-first technique is a safe and suitable a lternative to the 2-stage procedure for repair of extensive thoracic aortic dis ease.
Staged procedures for extensive aneurysmal disease of the thoracic aorta are a ssociated with a substantial cumulativemortality(20%) that includes hospitalmor tality for the 2 procedures and death(often from aortic rupture) in the interval between the 2 procedures. We have used a single-stage technique for operative repair of most or all of the thoracic aorta. Forty-six patients with extensive disease of the thoracic aorta were managed with a single-stage procedure by usi ng a bilateral anterior thoracotomy and transverse sternotomy, hypothermic circu latory arrest, and reperfusion of the aortic arch vessels first to minimize brai n ischemia. Thirty-one patients with chronic, expanding type A aortic dissectio ns had previous operations for acute type A dissection(n=22), aortic valve repai r or replacement (n=4), coronary artery bypass grafting(n=4), or no previous ope ration(n=1). The remaining 15 patients had degenerative aneurysms(n=12) or chron ic type B dissections with proximal extension(n=3). The ascending aorta and aort ic arch were replaced in all patients combined with resection of various lengths of descending aorta(proximal one third[n=19], proximal two thirds to three quar ters [n=22], or all [n=5]). Coronary artery bypass grafting, valve replacement, or both were performed concomitantly in 19 patients. Hospital mortality was 6.5 %(3 patients). Morbidity included reoperation for bleeding(17%), mechanical ve ntilation for more than 72 hours(42%), temporary tracheostomy(13%), and tempor ary renal dialysis (9%). No patient sustained a stroke. There have been 5 late deaths(3, 18, 34, 51, and 79 months postoperatively) unrelated to the aortic dis ease. Four patients have undergone successful reoperation on the aorta(false ane urysm[n=1], endocarditis[n=1], and progression of disease [n=2]). Five-year sur vivalwas 75%. The single-stage, arch-first technique is a safe and suitable a lternative to the 2-stage procedure for repair of extensive thoracic aortic dis ease.
