Maam. Schepens et al., SURGICAL-TREATMENT OF THORACOABDOMINAL AORTIC-ANEURYSMS BY SIMPLE CROSS-CLAMPING - RISK-FACTORS AND LATE RESULTS, Journal of thoracic and cardiovascular surgery, 107(1), 1994, pp. 134-142
Between 1981 and 1987, 88 consecutive patients were operated on for a
thoracoabdominal aortic aneurysm by simple crossclamping and a graft i
nclusion technique (without shunts or heparin). This article presents
an analysis of the operative outcome and long-term follow-up. Patient-
and operation-related variables are age (mean 64.3 years, range 28 to
82 years), sex (82% men), rupture (20.5%), diabetes (2.3%), renal ins
ufficiency (34.1%), chronic obstructive pulmonary disease (27.3%), pre
vious aortic operation (31.8%), arterial hypertension (66%), postdisse
ction (18.2%) versus degenerative (80.7%) origin, preoperative shock (
11.4%), ischemic cerebrovascular (12.5%) or ischemic heart (17%) disea
se, peripheral vascular disease (14.8%), renal (mean 48 minutes, range
0 to 83 minutes) and lower spinal cord (mean 21 minutes, range 0 to 6
8 minutes) ischemic time, number of reattached intercostals, blood los
s, and extent of the aneurysm (Crawford classification: type I, 16 pat
ients [18.2%]; type II, 21 patients [23.8%]; type III, 29 patients [33
%]; and type IV, 22 patients [25%]. Intraoperative mortality is 1.1% (
n = 1). Thirty-day mortality is 5.9% (n = 5). Hospital mortality is 11
.4% (n = 10): 7% for elective cases and 28% for ruptured aneurysms (p
= 0.014). The survival at 2 years is 78% +/- (4.4%) and at 5 years 54%
+/- (5.3%). Postoperative spinal cord injury occurred in 12 patients
(13.8%) (5 had paraplegia and 7 had paraparesis) and postoperative ren
al dysfunction necessitating dialysis in 12 patients (14.1%). Risk str
atification for hospital death, late death, renal failure, and spinal
cord dysfunction was performed by means of multivariate logistic regre
ssion and Cox proportional hazard regression as appropriate. The best
fitting model to predict hospital death includes preoperative shock (p
= 0.02), female sex (p = 0.06), preoperative elevated serum creatinin
e level (p = 0.06), and preoperative myocardial infarction (p = 0.08).
Variables predictive for late death are postoperative dialysis (p = 0
.002), age (p = 0.008), and rupture (p = 0.04). The risk factors of po
stoperative dialysis are age (p = 0.003) and preoperative serum creati
nine level (p = 0.04). The risk of postoperative spinal cord dysfuncti
on increases with longer lower spinal cord ischemic time (p = 0.02) an
d with the presence of preoperative shock (p = 0.06).