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European Journal of Cardio-Thoracic Surgery, Vol 3, 37-42, Copyright © 1989 by European Association for Cardio-thoracic Surgery

ARTICLES

Surgical correction of descending thoracic aortic aneurysms with shunt or bypass techniques versus simple aortic cross-clamping

R Hamerlijnck, R De Geest, A Brutel de la Riviere, J Defauw, P Knaepen and F Vermeulen
Department of Cardiopulmonary Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands.

Between June, 1972, and January, 1986, 57 patients underwent resection of a descending thoracic aortic aneurysm using a shunt or bypass for distal aortic perfusion (group I, n = 29) or simple aortic cross- clamping, routinely used since mid-1983 (group II, n = 28). There was a statistically significant difference in the mean age of the patients: in group II it was 14 years higher than in group I (group I: 52.8 years, group II: 66.5 years). Of these 57 patients, 8 died in hospital (group I: 6 patients, group II: 2 patients). Hospital mortality was strongly related to preoperative rupture and the incidence of intraoperative complications. Postoperative paraplegia occurred in 3 patients, all in group I, and could be related to ligation of four or more intercostal arteries between T8 and T12. Postoperative renal failure, necessitating dialysis in 5 patients, was strongly related to intraoperative hypotension, and also to emergency procedures and pre- existing renal dysfunction. Intraoperative haemorrhage occurred more often using shunting or bypass techniques. Mortality, paraplegia and renal failure showed a decreasing trend after abandoning the use of adjunctive perfusion.

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