Surgical approach for repair of descending thoracic aortic aneurysms and postoperative respiratory function

Good exposure and the minimization of lung and thorax injuries are importan t objectives of surgery for descending thoracic aortic aneurysm (DTAA). In this study, three surgical approaches for DTAA were compared to assess post operative respiratory function. The subjects were 21 patients with DTAA, th ree of whom had a thoracoabdominal aneurysm. The mean age was 61 years, and there were 12 men and 9 women. The causes of aneurysm were atherosclerosis in 16 patients, chronic dissection in 4, and traumatic pseudoaneurysm in 1 . All the patients underwent femorofemoral partial cardiopulmonary bypass. The DTAA was replaced with a prosthetic graft in 18 patients and repaired w ith a patch graft in 3. Three approaches were selected, namely, posterolate ral thoracotomy (PL group, n = 12), median sternotomy combined with anterol ateral thoracotomy (M group, n = 5), and spiral incision (S group, n = 4). There were no significant differences in operation time, cardiopulmonary by pass time, intraoperative blood loss volume, or water balance. The duration of respiratory support and intensive care unit stay were significantly (P < 0.05) longer in the M group than in the other two groups. The alveolar-ar terial oxygen difference (AaDO(2)) and respiratory index (RI) levels immedi ately after surgery were also significantly (P < 0.05) higher in the M grou p than in the PL group. There were no significant differences in AaDO(2) an d RI levels 12 and 24h after surgery among the three groups. These results suggest that posterolateral thoracotomy is a desirable surgical approach fo r DTAA repair in view of the fact that it has the least effect on postopera tive respiratory function.