REPAIR FOR ANEURYSMS OF THE ENTIRE DESCENDING THORACIC AORTA OR THORACOABDOMINAL AORTA USING A DEEP HYPOTHERMIA

Objective: Replacement of the entire descending aorta or of the thorac oabdominal aorta still has a significant risk for postoperative parapl egia. Surgical strategies using a deep hypothermia to protect the spin al cord or viscera are discussed. Methods: From April 1994, 25 patient s underwent graft replacement of the entire descending aorta (13 patie nts) or thoracoabdominal aorta (12 patients) using a deep hypothermia. Five patients had atherosclerotic aneurysms and 20 had aortic dissect ion. There were 20 males and 5 females, whose age ranged from 26 to 72 years old, 47 years old in average. Surgery consisted with proximal a nastomosis using deep hypothermia (18 degrees C) with retrograde cereb ral perfusion by elevating central venous pressure tct 20 mmHg, recons truction of the intercostal arteries, and distal open anastomosis, whi le perfusing the brain and heart. Proximal open anastomosis was used w ith retrograde cerebral perfusion technique in IS patients. Averaged n umber of reconstructed intercostal arteries was 2.1 for each patient. Results: No early mortality was found and one patient died of respirat ory Failure 6 months after surgery. One patient had a postoperative st roke and one had a delayed onset of paraplegia 2 days after operation. The cause of paraplegia was secondary hypoxemia and hypotension due t o pneumonia. Conclusion: Utilization of the deep hypothermia in surger y for aneurysms of the entire descending aorta or of the thoracoabdomi nal aorta provided an adequate protection vf the spinal cord as well a s the abdominal viscera, eliminated clamp injury or cerebral embolizat ion of debris or thrombi, and afforded excellent surgical exposures. ( C) 1997 Elsevier Science B.V.