INFLUENCE OF THE USE OF A BYPASS ON THE RESULTS OF THORACOABDOMINAL AORTIC-ANEURYSM SURGERY

Objectives: To evaluate the influence of the use of a bypass on the re sults of thoracoabdominal aortic aneurysm surgery. Methods: The result s of the repair of 224 thoracoabdominal aortic aneurysms operated upon between 1981 and the end of 1996 were evaluated retrospectively. In 1 22 cases we used simple cross-clamping (clamp and sew technique) and i n 102 cases a left heart bypass (atrio-femoral or aorto-femoral) was t he preferred method. Except for the use of cerebrospinal fluid drainag e over the last years, the methods of spinal protection were the same in both groups. Renal protection was also identical in both groups. Al l aneurysms were repaired using the inlay technique. Results: Hospital mortality was 11.2%: 14.7% in cross-clamp group versus 6.8% in the by pass group (p = 0.04). Postoperative dialysis was necessary in 9.8%: 1 2.7% in the cross-clamp group versus 6.8% in the bypass group (p = 0.1 08). Paraplegia occurred in 8.4% : 7.4% in the cross-clamp group versu s 9.8% in the bypass group (p = 0.517). Using the highly predictive mo del of Acher, there would have been 33% spinal cord lesions in the byp ass group. Conclusions: Hospital mortality, postoperative dialysis and postoperative spinal cord problems are lowered by the use of a bypass during the repair of thoracoabdominal aortic aneurysms. These results evidence that the use of a bypass is indicated in this complex operat ion.