IS CLAMP AND SEW STILL VIABLE FOR THORACIC AORTIC RESECTION

Objective The authors reviewed the morbidity and mortality of surgical resection of the descending thoracic and thoracoabdominal aorta using the clamp-and-sew technique. Background Paraplegia remains a devastat ing complication after thoraoabdominal aortic resection, despite many strategies for spinal cord protection. Because of its simplicity, clam p and sew has been the preferred technique at the University of Virgin ia for thoracoabdominal aortic resection when proximal control is poss ible. Methods Between 1987 and 1994, the authors reviewed 91 consecuti ve patients who underwent thoracic aortic resection using damp-and-sew techniques without any additional adjuncts for spinal cord protection . Results The average age of patients was 60.8 years; 57.1% were male. No intraoperative deaths occurred. In-hospital mortality was 13% (12/ 91), with an overall incidence of postoperative spinal cord injury man ifested as paraparesis or paraplegia of 9.9% (9/91). Eighty-nine perce nt (81/91) of all repairs were completed with aortic clamp times of 40 minutes or less, and nearly six out of ten were completed in 30 minut es or less (53/91). Cross-clamp times were not significantly different between those patients who sustained neurologic injury and those who had no deficits Conclusions The authors conclude that clamp and sew is still a viable technique for thoracoabdominal aortic resection. Nearl y all resections can be completed within 40 minutes of aortic occlusio n. However, the ''safe'' duration of thoracic aortic occlusion remains unknown, and spinal cord injury can occur even with short clamp times . Reproducible, safe, and technically simple means of spinal cord prot ection must be developed.