Document Detail

Optimization of aortic arch replacement: two-stage approach.
MedLine Citation:
PMID:  17257933     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Aneurysms of the aortic arch seldom occur alone. They usually involve the ascending aorta. Occasionally, the aneurysm also involves the descending thoracic or thoracoabdominal aorta. We advocate a staged approach for repair of these extensive aortic aneurysms, with the ascending and arch generally being repaired in the first stage and the descending thoracic or thoracoabdominal aorta being repaired in the second stage. METHODS: Between February 1991 and December 2005, we repaired aneurysms of the ascending, arch, descending thoracic, and thoracoabdominal aorta in 2120 patients. Of these, 254 (12.0%) involved the ascending, arch, and descending aorta (extensive aortic aneurysm). A first-stage repair was done in 254 patients, and 115 returned for a second-stage repair for a total of 369 procedures performed. RESULTS: First-stage 30-day mortality was 6.3% (16/254), with the glomerular filtration rate (GFR) exceeding 70 mL/min in 2.9% of patients and less than 70 mL/min in 10.5% (p < 0.03). Second-stage 30-day mortality was 9.6% (11/115), with GFR exceeding 70 mL/min in 4.9% and less than 70 mL/min in 9.8% (not significant). The incidence of postoperative stroke for the first stage was 2.0% (5/254), and the rate of neurologic deficit (paraplegia and paraparesis) was .9% (1/115) in the second stage. The mortality for the interval of 31 days to 6 weeks after the first-stage operation was 2.9% (7/238). CONCLUSIONS: Aneurysms involving the transverse arch with extensive involvement of the ascending and descending thoracic or thoracoabdominal aorta can be effectively repaired using the two-stage technique with acceptable morbidity and mortality. GFR correlates to surgical outcome in the first-stage repair. After the first stage, prompt treatment of the remaining segment of aorta is crucial to success.
Hazim J Safi; Charles C Miller; Anthony L Estrera; Martin A Villa; Jennifer S Goodrick; Eyal Porat; Ali Azizzadeh
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  83     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-01-29     Completed Date:  2007-03-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  S815-8; discussion S824-31     Citation Subset:  AIM; IM    
Department of Cardiothoracic and Vascular Surgery, The University of Texas at Houston Medical School, Memorial Hermann Heart and Vascular Institute, Houston, Texas 77030, USA.
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MeSH Terms
Aged, 80 and over
Aorta, Thoracic / surgery*
Aortic Aneurysm / physiopathology,  surgery*
Blood Vessel Prosthesis Implantation / adverse effects,  methods*,  mortality,  standards
Glomerular Filtration Rate
Middle Aged
Paraparesis / etiology
Paraplegia / etiology
Stroke / epidemiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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