STAGED REPAIR OF EXTENSIVE AORTIC-ANEURYSM - IMPROVED NEUROLOGIC OUTCOME

Objective We reviewed the adjuncts for brain and spinal cord protectio n and modifications of operative techniques. Summary Background Data T wo-staged repair-the ''elephant trunk'' technique-has provided the mea ns for successful repair of massive aortic aneurysms, although histori cally morbidity has been high. Methods Between February 1991 and Febru ary 1996, we operated on 512 patients for thoracic aortic aneurysm. Pr eoperative, intraoperative, or postoperative predictors of morbid outc omes were studied in 63 patients treated with the elephant trunk techn ique. Data were analyzed by contingency table methods. Results After s tage 1, there were no strokes among patients who received retrograde c erebral perfusion (0 of 53), two strokes occurred among patients who d id not receive retrograde cerebral perfusion (2 of 10 [20%]), and earl y mortality occurred in 4 of the 63 patients (6%). Interval mortality occurred in 6 of 59 patients (10%); 3 (50%) of these 6 deaths were due to distal aortic aneurysm rupture. Thirty-eight patients have undergo ne stage two repair thus far. There was no incidence of neurologic def icit after stage 2, and early mortality occurred in 1 of the 38 patien ts (3%). Conclusions Extensive aortic aneurysm can be successfully tre ated using the elephant trunk technique. in this group of patients, re trograde cerebral perfusion eliminated neurologic complications.