Quick, simple clamping technique in descending thoracic aortic aneurysm repair

Background. Although significant advances have been made in the surgical tr eatment of diseases affecting the descending thoracic aorta, paraplegia rem ains a devastating complication. We propose the quick, simple clamping tech nique to prevent spinal cord ischemic injury. Methods. From 1983 to 1998, 143 patients had descending thoracic aorta aneu rysm repair. We divided the patients into the following three groups accord ing to the surgical technique used: selective atriodistal bypass was used i n group 1 (66 patients); simple clamping technique in group 2 (28 patients) ; and quick simple clamping technique in group 3 (49 patients). Mean aortic cross clamp time was 39 +/- 13 minutes in group 1, 37 +/- 11 minutes in gr oup 2, and 17 +/- 6 minutes in group 3 (p < 0.01 group 3 versus group 1 and group 2). Results. The overall incidence of paraplegia was 4.8% (7 patients), 4.5% (3 patients) in group 1, 14.3% (4 patients) in group 2, and 0 in group 3 (p < 0.05 group 3 versus group 2). The overall in-hospital mortality rate was 5 .5%. Multivariate logistic regression analysis showed a powerful effect of aortic cross-clamping time as risk factor for both paraplegia (p < 0.008), with an odds ratio of 1.03 per minute, and in-hospital mortality (p < 0.001 ), with an odds ratio of 2.5 per minute. The mean follow-up time was 65 mon ths with a lower overall mortality rate in group 3 than in group 1 and grou p 2 (p < 0.05). Conclusion. In descending thoracic aortic aneurysm repair, spinal cord perf usion can be maintained adequately without reimplantation of segmental vess els or use of atriodistal bypass when the aortic cross-clamp time is short (< 15 to 20 minutes). (Ann Thorac Surg 1999;67:1038-44) (C) 1999 by The Soc iety of Thoracic Surgeons.