Surgical treatment of aortic aneurysm and aortic dissection: A retrospective analysis of 122 cases

Abstract

The study summarizes the clinical experience of surgical treatments of various types of thoracic aneurysm and aortic dissection. Clinical data of 122 patients with thoracic aneurysm and aortic dissection during July 2005 to July 2008 were retrospectively analyzed. The elective operations were performed in 107 patients while emergency surgery was done in 15 cases. Different surgical strategies were employed on the basis of diseased region, including simple ascending aortic replacement (n=3), aortic root replacement (n=43), hemi-arch replacement /total arch replacement + elephant trunk technique (n=32), thoracic/thoracoabdominal aortic replacement (n=8) and endovascular repair (n=36). In this series, there is 4 cases of perioperative death due to massive cerebral hemorrhage (n=1), respiratory failure (n=1) and multiple organ dysfunction syndrome (MODS) (n=2). Three cases developed post-operative massive cerebral infarction and the relatives of the patients abandoned treatment. Instant success rate of endovascular repair was 100%. The intimal rupture was sealed. Blood flow was unobstructed in true lumen and no false lumen was visualized. It was concluded that aggressive surgery should be considered in the patients with thoracic aneurysm and aortic dissection. Surgical procedures should vary with the location and the nature of the lesions.

Keywords

thoracic aneurysm / aortic dissection / hybrid operation / endovascular repair

References

[1] YusufS.W., MarinM.L., IvancevK., et al. . Operative Atlas of Endoluminal Aneurysm Surgery, 2000, Oxiford, Isis Medical Ltd: 118-135

[2] KatoM., OhnishiK., KanekoM., et al. . New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft. Circulation, 1996, 94(9s): II188-193

[3] MizunoT., ToyamaM., TabuchiN., et al. . Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection. Eur J Cardiothorac Surg, 2002, 22(4): 504-509

[4] SunL.Z., LiuZ.G., ChangQ., et al. . Treatment of stanford A aortic dissection with aortic arch replacement plus stented elephant trunk operation. Chin Surg J (Chinese), 2004, 42(13): 812-816

[5] AzizzadehA., EstreraA.L., PoratE.E., et al. . The hybrid elephant trunk procedure: a single-stage repair of an ascending, arch, and descending thoracic aortic aneurysm. J Vasc Surg, 2006, 44(2): 404-407

[6] ParodiJ.C., PalmazJ.C., BaroneH.D., et al. . Transfemoral intraluminal graft implantation for abdominal aortic aneurysm. Ann Vasc Surg, 1991, 5(5): 491-499

[7] WuY.B., ChangQ., ZhuJ.M., et al. . Analysis for pre-operative death in 76 cases of acute aortic dissection. Bull Chin Society Thorac Cardiovasc Surg (Chinese), 2008, 12(2): 27-29

[8] PessotoR., SantiniF., PuglieseP., et al. . Preservation of the aortic valve in acute type A dissection complicated by aortic regurgitation. Ann Thorac Surg, 1999, 67(6): 2010-2013

[9] DakeM.D., MillerC., SembaC.P., et al. . Transluminal placement of endovascular stent-grafts for treatment of descending thoracic aortic aneurysm. N Eng J Med, 1994, 331(26): 1729-1734

[10] JingZ.P., ZhaoJ.. Clinical application and research of treatment of thoracic-abdominal anuerysm with endovascular isolation technique. Surg Theory Practice (Chinese), 1998, 3(4): 203

[11] GuoW., YangD.H.. Management of aortic arch branches during endovascular repair. Surg Theory Practice (Chinese), 2007, 12(1): 10-12

[12] WangS.M.. Endovascular treatment of Stanford A aortic dissection. Surg Theory Pract (Chinese), 2007, 12(1): 7-9

[13] OkitaY., MinatoyaK., TagusartO., et al. . Prospective comparative study of brain protection in total aortic arch replacement: deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion. J Ann Thorac Surg, 2001, 72(1): 72-79

[14] WangG.Y., LiL.H., LiuJ.P., et al. . Application of general anaesthesia plus deep hypothermia and circulatory arrest and selective cerebral perfusion in aortic arch replacement and stented elephant trunk technique. Chin J Extra Corpor Circ (Chinese), 2005, 3(2): 93-95

[15] JacobsM.J., MeylaertsS.A., de HaanP., et al. . Strategies to prevent neurologic deficit based on motor-evoked potentials in type I and II thoracic abdominal aortic aneurysm repair. J Vasc Surg, 1999, 29(1): 48-57

[16] Leal-NovalS.R., Marquez-VácaroJ.A., García-CurielA., et al. . Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Med, 2000, 28(4): 935-40

[17] ShafirR., WeissJ., GurE., et al. . Sternal wound infection: our experience with 200 cases. J Cardiovasc Surg (Torino), 1994, 35(6Suppl1): 103-104