Total thoracoabdominal aortic aneurysm repair: a normal thermic and non-cardiopulmonary bypass method / 中华胸心血管外科杂志

ABSTRACT

Objective Investigate the operative techniques and early results of a normal thermic and non-cardiopulmonary bypass fashion to perform total thoracoabdominal aortic aneurysm repair (tTAAAR).Methods Between February 2009 and December 2010,41 patients with extensive Crawford Ⅱ thoracoabdominal aortic aneurysm (TAAA) underwent tTAAAR in our hospital.Among them,27 patients underwent tTAAAR in a normal thermic and non-cardiopulmonary bypass fashion.The mean age of this group of patients is (41.85 ± 10.11 ) years ( range 23-61 years),including 18 male and 9 female.The operation was performed via a combined left thoracoabdominal incision.The intercostal incision was through the left fifth (or sixth) intercostal space and an amputated costal arch.The abdominal incision was from the left linea pararectalis to the level of the pubic symphysis via a retroperitoneal approach.The diaphragm was incised circularly to expose the aorta.After the iliac arteries and proximal descending aorta were dissected and exposed sufficiently,two 10 mm side branches were anastomosed to iliac arteries in an end to side fashion.When this was accomplished,the proximal end of the main graft was anastomosed to the proximal descending aorta in an end to end fashion.Then the bypass from descending aorta to bilateral iliac arteries was established under normal thermia.The reestablishment of intercostal arteries and visceral arteries was followed with subsection circulatory arrest.Results The procedure was succeeded in all 27 patients but 1 patient died during operation because of pulmonary hemorrhage.The mean descending aortic circulatory arrest time was ( 13.78 ± 3.77 ) min,the spinal cord ischemia time was ( 19.19 ± 3.93 ) min,and the visceral organs ischemia time was ( 25.19 ± 5.88 ) min,respectively.Mean intubation time is (24.62 ±21.70) hours.Mean ICU stay time is ( 1.84 ± 1.29) days.Two of the 26 survivors suffered permanent spinal cord injury.The morbidity of pulmonary complication,temporal cerebral complications,renal failure,reoperation for hemorrhage,and delayed healing of incision was 11.54％,3.85％,3.85％,3.85％,7.69％,respectively.One Marfan patient suffered Stanford type A aortic dissection after 9 days of tTAAAR.She was rescued by emergency operation.Mean follow-up time was ( 16.04 ± 5.62 ) months,with a follow-up rate of 100％.No late death was found.Conclusion The normal thermic and noncardiopulmonary bypass tTAAAR is a reliable and effective therapeutic strategy for these patients.But the indication of this procedure is limited.If the thoracoabdominal aortic aneurysm grows too huge,the normal thermic tTAAAR cant be performed.So the TAAA patients in China should be treated in their early stage.