Document Detail


Risk of replacement of descending aorta with a standardized left heart bypass technique.
MedLine Citation:
PMID:  8283874     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Replacement of the descending aorta for aneurysms (51%) and dissection (49%) was performed in 132 patients with a highly standardized left heart vortex-pump bypass. No adjuncts other than staged aortic clamping and intercostal artery reconnection were used to reduce spinal cord injury in extensive involvement. Four patients (3%) died early, two of cardiac cause, and nine (7%) died late. Complications of vital organ function occurred in eight patients, two having reversible renal failure and six spinal cord injury that was permanent in three (2.3%). Cord injury occurred only in replacement beyond thoracic segment 8 and could not be completely avoided despite distal intercostal artery reconnection in two cases; in the other four cases such vessels either did not appear worth reconnecting or were sacrificed in emergency operations. We conclude that left heart bypass effectively unloads the proximal circulation during aortic occlusion while maintaining adequate perfusion of distal vital organs as evidenced by low rates of early mortality and renal failure. The remaining risk of spinal cord damage may be lowered by more aggressive reconnection of all distal intercostal arteries and by extending the permissible cord ischemic period by means of hypothermia.
Authors:
H G Borst; M Jurmann; B Bühner; J Laas
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  107     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1994 Jan 
Date Detail:
Created Date:  1994-02-14     Completed Date:  1994-02-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  126-32; discussion 132-3     Citation Subset:  AIM; IM    
Affiliation:
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aneurysm, Dissecting / surgery
Aorta, Thoracic / surgery*
Aortic Aneurysm, Thoracic / surgery
Cardiopulmonary Bypass* / adverse effects
Female
Humans
Ischemia / etiology
Male
Middle Aged
Paraplegia / etiology
Postoperative Complications
Spinal Cord / blood supply

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


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