OPERATION FOR NONDISSECTING ANEURYSM IN THE DESCENDING THORACIC AORTA

Background. Little is known about the risks of mortality and morbidity after descending thoracic aortic aneurysm repair using left heart byp ass and temporary arterioarterial bypass. Methods. A multicenter, retr ospective study was performed on 120 patients who were admitted to one of nine cardiovascular centers between January 1988 and December 1993 and underwent operation for nondissecting thoracic aortic aneurysm. T he present series included 10 patients with ruptured aneurysm. Graft r eplacement was performed in 95 patients, patch repair in 22, and sutur e of the ruptured aorta in 3. Venoarterial bypass was used in 45 patie nts, left heart bypass in 56, and temporary arterioarterial bypass in 19 as circulatory support. The mean postoperative follow-up period was 30 +/- 21 months. Results. Hospital mortality occurred in 7 patients (5.8%). Univariate analysis revealed that only aneurysmal rupture was related to hospital mortality. Brain or cord injury was observed in 4. Of nine deaths that occurred after discharge, five were related to an eurysm and two were due to vascular event. No significant difference w as noticed in probability of survival according to the circulatory sup porting method. Only aneurysmal rupture affected probability of surviv al. Multivariate analysis revealed that aneurysmal rupture was the onl y independent predictor for vascular death including hospital mortalit y. Conclusions. The present study confirms that aneurysmal rupture is a significant predictor for mortality and morbidity in aortic operatio ns for nondissecting descending thoracic aneurysm, and that a similarl y good outcome would be expected when using left heart bypass, tempora ry arterioarterial bypass, or venoarterial bypass. (C) 1997 by The Soc iety of Thoracic Surgeons