THORACOABDOMINAL ANEURYSM REPAIR - SPINAL-CORD PROTECTION USING PROFOUND HYPOTHERMIA AND CIRCULATORY ARREST

Between January 1991 and February 1993, 14 patients (11 male, 3 female ) between 21 and 79 years of age (median 50 years) underwent reconstru ction of the thoracic (n = 7) and thoracoabdominal aorta (n = 7). Four patients had previously undergone operation of the ascending aorta, a nd in three patients coronary artery bypass grafting had previously be en performed. All patients were operated on via a posterolateral thora cotomy using cardiopulmonary bypass with continuous blood cardioplegia and hypothermic circulatory arrest (11-degrees-C nasopharyngeal tempe rature, flat-EEG). All patent lower intercostal and lumbar arteries (T 3 to L5) were reimplanted. The 30-day mortality after repair of the th oracic aorta was 0%; after replacement of the thoracoabdominal aorta, mortality was 28.5% (n = 2). One patient died 70 days after replacemen t of the thoracic aorta as a consequence of a perioperative stroke. No ne of the surviving 11 patients developed a permanent neurological def icit or renal or cardiac dysfunction. The average intensive care stay was 6 days for patients after replacement of the thoracic aorta and 18 days for patients after replacement of the thoracoabdominal aorta. Ou r results suggest that use of elective hypothermia and circulatory arr est for spinal cord protection is highly effective. We, therefore, rec ommend this method for complex reconstructions of the thoracoabdominal aorta.