OBJECTIVE: To apply fractionated-clamping for repair of thoracoabdominal aortic aneurysm (TAA), and evaluate its effects in decreasing surgical mortality and severe complications, such as renal failure and paraplegia,...OBJECTIVE: To apply fractionated-clamping for repair of thoracoabdominal aortic aneurysm (TAA), and evaluate its effects in decreasing surgical mortality and severe complications, such as renal failure and paraplegia, a modified crawford procedure were prospectively evaluated. METHODS: Using modified shunting and cross-clamping techniques, modified Crawford repair in 13 thoracoabdominal aorta patients were performed in the Vascular Division at Peking Union Medical College Hospital. TAA Crawford classification: 1 type I, 2 type II, 2 type III and 3 type IV TAA. Debakey classification: 1 type I, 4 type III (including 2 ruptured aneurysms), and 1 aortic coarctation. RESULTS: Thirteen procedures were performed successfully. One died of ventricular fibrillation just before completing the operation. Surgical mortality rate was 7.7% (1/13). Postoperative complications included 1 acute necrotic pancreatitis, 1 ARDS, 1 paraplegia, 1 acute renal failure, and 2 thoracic cavity bleeding. Total complication rate was 53.8% (7/13). CONCLUSIONS: Fractionated-clamping in thoracoabdominal aortic aneurysm repair is our modified Crawford procedure and aortic bypass. Clinical results demonstrate that our procedure decreased surgical mortality and major complication rate, and also alleviated viscera ischemic injury. Fractionated-clamping in aorta replacement is a practical procedure for TAA repair under general anesthesia at normal temperature.展开更多
Objective To report our operative experience with aortic root replacement in 231 patients with aortic root aneurysm and discuss the current indications, methods, and surgical techniques、Methods Between January 1994...Objective To report our operative experience with aortic root replacement in 231 patients with aortic root aneurysm and discuss the current indications, methods, and surgical techniques、Methods Between January 1994 and August 1999, a group of 231 consecutive patients underwent aortic root replacement at our hospital, with 13 being treated on an emergency basis、 There were 189 men and 42 women, ranging in age from 14 to 69 years、 The diameter of the aneurysm varied from 4、5 to 11?cm、 Among this group, 145 had isolated aortic root aneurysms, 65 suffered from DeBakey type Ⅰ aortic dissection, and the remaining 21 were diagnosed as having DeBakey type Ⅱ aortic dissection、 Aortic valve regurgitation occurred in all cases、 Aortic root replacement was performed with composite valved graft in 229 patients, and in 2 patients the aortic valve was preserved、Results The hospital mortality rate was 3、03% (7 patients)、 Early complications included re-exploration for bleeding in 6 patients, pericardial effusion in 9, as well as cerebral infarction, pleural effusion, and pneumothorax in 2 patients each、 One hundred and seventy-five patients (78、12%) were followed up, with a mean follow-up time of 15、7±13、1 months (range, 2 weeks to 65 months)、 One patient died from lower-limb embolism and renal dysfunction 3 months postoperatively、 Three patients died from postoperative anticoagulation accidents、 The preoperative and postoperative mean left ventricular end-diastolic diameters were significantly different (68、1±9、4?mm, range 54 to 112?mm; vs 54、8±8、2?mm, range 38 to 88?mm; P<0、001)、Conclusions Once a diagnosis of acute aortic root dissecting aneurysm is made, the patient should undergo surgery as soon as possible if the general conditions permit、 Aortic aneurysm without dissection or with chronic dissection should be operated if the diameter of the aneurysm is greater than 5?cm展开更多
文摘OBJECTIVE: To apply fractionated-clamping for repair of thoracoabdominal aortic aneurysm (TAA), and evaluate its effects in decreasing surgical mortality and severe complications, such as renal failure and paraplegia, a modified crawford procedure were prospectively evaluated. METHODS: Using modified shunting and cross-clamping techniques, modified Crawford repair in 13 thoracoabdominal aorta patients were performed in the Vascular Division at Peking Union Medical College Hospital. TAA Crawford classification: 1 type I, 2 type II, 2 type III and 3 type IV TAA. Debakey classification: 1 type I, 4 type III (including 2 ruptured aneurysms), and 1 aortic coarctation. RESULTS: Thirteen procedures were performed successfully. One died of ventricular fibrillation just before completing the operation. Surgical mortality rate was 7.7% (1/13). Postoperative complications included 1 acute necrotic pancreatitis, 1 ARDS, 1 paraplegia, 1 acute renal failure, and 2 thoracic cavity bleeding. Total complication rate was 53.8% (7/13). CONCLUSIONS: Fractionated-clamping in thoracoabdominal aortic aneurysm repair is our modified Crawford procedure and aortic bypass. Clinical results demonstrate that our procedure decreased surgical mortality and major complication rate, and also alleviated viscera ischemic injury. Fractionated-clamping in aorta replacement is a practical procedure for TAA repair under general anesthesia at normal temperature.
文摘Objective To report our operative experience with aortic root replacement in 231 patients with aortic root aneurysm and discuss the current indications, methods, and surgical techniques、Methods Between January 1994 and August 1999, a group of 231 consecutive patients underwent aortic root replacement at our hospital, with 13 being treated on an emergency basis、 There were 189 men and 42 women, ranging in age from 14 to 69 years、 The diameter of the aneurysm varied from 4、5 to 11?cm、 Among this group, 145 had isolated aortic root aneurysms, 65 suffered from DeBakey type Ⅰ aortic dissection, and the remaining 21 were diagnosed as having DeBakey type Ⅱ aortic dissection、 Aortic valve regurgitation occurred in all cases、 Aortic root replacement was performed with composite valved graft in 229 patients, and in 2 patients the aortic valve was preserved、Results The hospital mortality rate was 3、03% (7 patients)、 Early complications included re-exploration for bleeding in 6 patients, pericardial effusion in 9, as well as cerebral infarction, pleural effusion, and pneumothorax in 2 patients each、 One hundred and seventy-five patients (78、12%) were followed up, with a mean follow-up time of 15、7±13、1 months (range, 2 weeks to 65 months)、 One patient died from lower-limb embolism and renal dysfunction 3 months postoperatively、 Three patients died from postoperative anticoagulation accidents、 The preoperative and postoperative mean left ventricular end-diastolic diameters were significantly different (68、1±9、4?mm, range 54 to 112?mm; vs 54、8±8、2?mm, range 38 to 88?mm; P<0、001)、Conclusions Once a diagnosis of acute aortic root dissecting aneurysm is made, the patient should undergo surgery as soon as possible if the general conditions permit、 Aortic aneurysm without dissection or with chronic dissection should be operated if the diameter of the aneurysm is greater than 5?cm
