Experience with thoracoabdominal aortic aneurysm resection.

From 1984 to 1993, 48 thoracoabdominal aortic aneurysm resections were performed. The patient age ranged from 21 to 79 years (mean: 65.5 years), and the extent of the aneurysms were as follows: type I (most of descending and upper abdominal), 17 cases; type II (most of descending and most of abdominal), 3 cases; type III (distal descending and upper abdominal), 20 cases; and type IV (most or the entire abdominal aorta), 8 cases. Ten patients presented with ruptured aneurysms, 1 with hemoptysis, 20 with pain, and 20 with no symptoms. Operation was performed using simple aortic cross-clamping in 18 patients, distal perfusion via Gott shunt in 6, and heparinless left-heart bypass (Biomedicus pump) in 24. Intercostal or lumbar vessels were reimplanted into the graft in 13 patients. Aortic cross-clamp time was 25 to 115 minutes (mean: 49.6 minutes). Four of 10 patients (40%) with ruptured aneurysms and 3 of 38 (8%) patients with non-ruptured aneurysms died. Serious complications included paraparesis in 2 patients (5%), renal failure requiring dialysis in 2 (5%), stroke in 1 (2%), bleeding in 5 (12%), intraoperative cardiac arrest in 3 (7%), sepsis in 1 (2%), prolonged ventilation (longer than 3 days) in 11 (27%), and wound dehiscence in 2 (5%). Thoracoabdominal aneurysm resection remains a challenging problem but can be performed with acceptable risk in selected patients. Distal heparinless perfusion without a heat exchanger may help reduce the risk of paraplegia and renal failure.