Perioperative determinants of mortality and morbidity in distal arch and proximal descending aortic aneurysm surgery
Hakan Posacioğlu, Fatih Islamoğlu, Anil Ziya Apaydin, Tanzer Calkavur, Tahir Yağdi, Yüksel Atay, Suat Büket
Med Sci Monit 2004; 10(4): CR137-142
Background:The purpose of this article is to describe our experience on distal arch and proximal descending aortic aneurysm repair, and to evaluate retrospectively the determinants of mortality and morbidity.Material/Methods: Between 1994 and 2002, 30 patients (mean age 53.4 years) underwent repair of distal arch or proximal descending aortic aneurysm approached through left thoracotomy with deep hypothermic circulatory arrest. Femoro-femoral bypass was used in all patients except for four, in whom the left subclavian artery was cannulated. Retrograde cerebral perfusion was performed in 16 patients. The mean circulatory arrest time was 30.7 min.Results: Overall hospital mortality was 13.3%. Excessive blood (p=0.008) and plasma (p=0.009) transfusions, and coronary artery disease (p=0.012) were correlated with mortality. The overall rate of postoperative complications was 30%. Renal failure and respiratory failure were the most frequent complications (16.7%), while the rates of stroke and transient neurological dysfunction were 6.7% and 3.3%, respectively. Age >70 years, bypass time >140 min, distal ischemia time >55 min, and excessive blood or plasma transfusions were determinants of postoperative complications.Conclusions: Deep hypothermic circulatory arrest with left thoracotomy is a valid procedure with acceptable mortality rates in the management of aneurysms of distal arch and proximal descending aorta. Prolonged bypass and distal ischemia times and excessive blood transfusions are associated with increased postoperative morbidity.
Keywords: Adult, Aged, Aorta, Thoracic - surgery, Aortic Aneurysm - mortality, Aortic Aneurysm - surgery, Cerebrovascular Accident - etiology, Cerebrovascular Disorders - etiology, Female, Heart Bypass, Left, Hospital Mortality, Humans, Kidney Failure - etiology, Male, Middle Aged, Postoperative Complications, Respiratory Insufficiency - etiology, Adult, Aged, Aorta, Thoracic - surgery, Aortic Aneurysm - surgery, Cerebrovascular Disorders - etiology, Female, Heart Bypass, Left, Hospital Mortality, Humans, Male, Middle Aged, Postoperative Complications, Renal Insufficiency - etiology, Respiratory Insufficiency - etiology, Stroke - etiology