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Replacement of descending aorta under partial cardiopulmonary bypass: still a gold standard
K. Minatoya, H. Ogino, H. Matsuda, H. Sasaki, J. Kobayashi, T. Yagihara, S. Kitamura. National Cardiovascular Center, Osaka, Japan,
BACKGROUND: Surgical replacement is our standard strategy for descending aortic aneurysm, despite of the advent of thoracic endoprosthesis. We retrospectively analyzed the outcome of the descending aortic repair under partial cardiopulmonary bypass (PCPB).
METHODS: Since 1994, 113 patients underwent graft replacement of descending aorta (mean age 68±12, 75 male) for non-dissecting aneurysm. There were 16 emergencies (14.2%). All operations were performed through left thoracotomy under PCPB with segmental clamping. Since 1998, preoperative MR angiography has been performed to detect Adamkiewicz artery for an elective case. Motor evoked potential has been measured recently.
RESULTS: The early mortality rate was 5.3% (6 of 113) in total, 1.0% (1 of 97) in elective cases, and 31.3% (5 of 16) in emergencies. The rate of spinal cord dysfunction was 2.7% (3 of 113) in total, 1.0% (1 of 97) in elective cases, and 12.5% (2 of 16) in emergencies. The stroke rate were 7.1% (8 of 113) in total, 4.1% (4 of 97) in elective cases, and 25.0% (4 of 16) in emergencies. The rate of respiratory failure was 9.7% (11 of 113) in total, 9.2% (9 of 97) in elective cases, and 12.5% (2 of 16) in emergencies.
CONCLUSIONS: Although the open surgical procedure is more invasive than stent-graft repair, the replacement of descending aorta under PCPB was performed with a comparable risk with the thoracic endoprosthesis.
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