Objectives: To examine the clinical profiles, operative outcomes, and late results of patients with pseudoaneurysm of the thoracic aorta. Methods: From 1990 to 2002, 60 patients underwent repair of aortic pseudoaneury...Objectives: To examine the clinical profiles, operative outcomes, and late results of patients with pseudoaneurysm of the thoracic aorta. Methods: From 1990 to 2002, 60 patients underwent repair of aortic pseudoaneurysm: ascending aorta in 70%, ascending aorta and arch in 15%, descending aorta in 10%, and arch alone in 5%. Mean age was 53±15 years, and 70%were men. Of these, 50(83%) had undergone previous cardiac surgery, including 22(37%) composite valve graft operations. The preferred cannulation site was femoral-femoral(n=27, 45%), with deep hypothermic circulatory arrest in 62%and retrograde cerebral perfusion in 33%; more recently, however, axillary cannulation has been preferred. Results: Principal etiologies were graft infection in ascending aorta pseudoaneurysm and trauma in descending aorta pseudoaneurysm. Fifteen patients(25%) presented with chest pain, 13(22%) with heart failure, and 20%with moderate or severe aortic regurgitation. The pseudoaneurysm was resected and the aorta replaced(n=45, 75%) or repaired(n=15, 25%) using various methods. Hospital mortality was 6.7%(n=4). Reexploration for bleeding was required in 8.3%, and 3.3%had postoperative stroke. At 30 days, 5 years, and 10 years, survival was 94%, 74%, and 60%and freedom from reoperation was 95%, 77%, and 67%, respectively. Conclusions: Most patients with aortic pseudoaneurysm require ascending aorta and/or arch replacement, which can be accomplished with low operative mortality and morbidity. Long-term survival and freedom from reoperation in these young patients parallel those expected for complex cardiac and aortic disease.展开更多
文摘Objectives: To examine the clinical profiles, operative outcomes, and late results of patients with pseudoaneurysm of the thoracic aorta. Methods: From 1990 to 2002, 60 patients underwent repair of aortic pseudoaneurysm: ascending aorta in 70%, ascending aorta and arch in 15%, descending aorta in 10%, and arch alone in 5%. Mean age was 53±15 years, and 70%were men. Of these, 50(83%) had undergone previous cardiac surgery, including 22(37%) composite valve graft operations. The preferred cannulation site was femoral-femoral(n=27, 45%), with deep hypothermic circulatory arrest in 62%and retrograde cerebral perfusion in 33%; more recently, however, axillary cannulation has been preferred. Results: Principal etiologies were graft infection in ascending aorta pseudoaneurysm and trauma in descending aorta pseudoaneurysm. Fifteen patients(25%) presented with chest pain, 13(22%) with heart failure, and 20%with moderate or severe aortic regurgitation. The pseudoaneurysm was resected and the aorta replaced(n=45, 75%) or repaired(n=15, 25%) using various methods. Hospital mortality was 6.7%(n=4). Reexploration for bleeding was required in 8.3%, and 3.3%had postoperative stroke. At 30 days, 5 years, and 10 years, survival was 94%, 74%, and 60%and freedom from reoperation was 95%, 77%, and 67%, respectively. Conclusions: Most patients with aortic pseudoaneurysm require ascending aorta and/or arch replacement, which can be accomplished with low operative mortality and morbidity. Long-term survival and freedom from reoperation in these young patients parallel those expected for complex cardiac and aortic disease.
