EFFECT OF EXTENDED CROSS-CLAMP TIME DURING THORACOABDOMINAL AORTIC-ANEURYSM REPAIR

Background. In previous studies of the neurologic outcome of patients undergoing thoracoabdominal aortic aneurysm repair with the simple cro ss-clamp technique, doss-clamp time of greater than 30 minutes was ide ntified as an important risk factor. We retrospectively examined the e ffect of clamp time of 30 minutes or greater on outcome for patients u ndergoing repair with the addition of surgical adjuncts. Methods. Betw een February 1991 and June 1996 we operated on 370 patients for thorac oabdominal or descending thoracic aortic aneurysm. Two hundred seventy -one of these patients with cross-clamp times of 30 minutes or greater were included in this study. One hundred twelve patients underwent si mple cross-clamp repair, whereas 159 were operated on with the surgica l adjuncts of distal aortic perfusion and cerebrospinal fluid drainage . Results. By multivariate analysis, acute dissection, surgical adjunc ts, and aneurysm extent proved most significant in overall patient out come. The overall rate of early neurologic deficits was 23 of 271 (8.5 %). For highest risk patients with type II thoracoabdominal aortic ane urysms, the rate of neurologic deficits was 11 of 29 (38%) for cross-c lamp versus 6 of 82 (7.3%) for adjunct operation patients (odds ratio = 0.13; p < 0.001). Conclusions. The adjuncts of cerebrospinal fluid d rainage and distal aortic perfusion decreased the risk of extended cro ss-clamp time during thoracoabdominal aortic aneurysm repair, particul arly for highest risk type II. (Ann Thorac Surg 1998;66:1204-9) (C) 19 98 by The Society of Thoracic Surgeons.