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.