ONE-STAGE SEGMENTAL RESECTION OF EXTENSIVE THORACOABDOMINAL ANEURYSMSWITH LEFT-SIDED HEART BYPASS

Purpose: The purpose of this study is to describe a technique for rese ction of extensive thoracoabdominal aneurysms, which the authors belie ve will lower morbidity and mortality rates. Methods: In an effort to minimize the risk of spinal cord ischemia, we have used a combination of sided heart bypass (left atrium to left femoral artery) with local cooling of the intercostal and visceral arteries and segmental resecti on of the aneurysm. Segmental resection of the aneurysm allows perfusi on of the spinal cord and abdominal viscera as the proximal anastomosi s is completed and as each pair of intercostal arteries is reimplanted . An attempt is made to reimplant all pairs of intercostal arteries fr om T8 to L2. Before the intercostal or visceral arteries are reimplant ed, that segment of aorta is cooled with cold crystaloid solution. Thu s no segment of the aorta is exposed to warm ischemia for more than 30 minutes. Left-sided heart bypass allows the patient's temperature to be maintained between 35-degrees and 37-degrees-C. Results: We have us ed this technique in 23 patients with types I and II (Crawford's class ification) thoracoabdominal aneurysms. Seven patients (30%) had dissec tions or rapture associated with their aneurysms and underwent emergen cy operation. One of these seven patients became paraplegic after oper ation, for a 4.3% incidence of paraplegia. One patient died of multipl e organ failure after operation. No patient had kidney failure requiri ng dialysis. Conclusions: We believe that our technique allows the ope ration to be performed in a deliberate manner with a low incidence of paraplegia and kidney failure.