REPAIR OF DESCENDING THORACIC ANEURYSMS THROUGH A LEFT POSTEROLATERALTHORACOTOMY USING DEEP HYPOTHERMIC CIRCULATORY ARREST

Aneurysms of the descending thoracic aorta are usually treated under s imple cross-clamping of the aorta. A shunt or partial bypass may be us ed to protect the heart and to maintain the distal circulation. Howeve r, situations exist where repair is only feasible using deep hypotherm ic circulatory arrest (DHCA). The aim of this retrospective study is t o describe the technique of DHCA through a left posterolateral thoraco tomy and to assess conditions in which this technique can be used. Fif teen patients with proximal descending thoracic aneurysms were treated using DHCA through a left posterolateral thoracotomy. Most of the int erventions were urgent. The decision to use DHCA was made intraoperati vely in 86% of the patients and was based mainly on local, unforeseen conditions. Early mortality was 13.3%, no late mortality was observed. The most frequent complications were respiratory (20%) and renal (13. 3%). Paraplegia or other neurologic disorders, temporary or permanent, were not encountered. Deep hypothermic circulatory arrest is a helpfu l tool in the management of difficult descending thoracic aorta aneury sms through a left posterolateral approach. In cases where simple cros s-clamping of the aorta is not possible, this technique offers a relia ble alternative with acceptable morbidity and mortality.