| Single-stage repair of extensive thoracic aortic aneurysms: experience with the arch-first technique and bilateral anterior thoracotomy. | |
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MedLine Citation:
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PMID: 15514593 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Staged procedures for extensive aneurysmal disease of the thoracic aorta are associated with a substantial cumulative mortality (>20%) that includes hospital mortality for the 2 procedures and death (often from aortic rupture) in the interval between the 2 procedures. We have used a single-stage technique for operative repair of most or all of the thoracic aorta. METHODS: Forty-six patients with extensive disease of the thoracic aorta were managed with a single-stage procedure by using a bilateral anterior thoracotomy and transverse sternotomy, hypothermic circulatory arrest, and reperfusion of the aortic arch vessels first to minimize brain ischemia. Thirty-one patients with chronic, expanding type A aortic dissections had previous operations for acute type A dissection (n = 22), aortic valve repair or replacement (n = 4), coronary artery bypass grafting (n = 4), or no previous operation (n = 1). The remaining 15 patients had degenerative aneurysms (n = 12) or chronic type B dissections with proximal extension (n = 3). The ascending aorta and aortic arch were replaced in all patients combined with resection of various lengths of descending aorta (proximal one third [n = 19], proximal two thirds to three quarters [n = 22], or all [n = 5]). Coronary artery bypass grafting, valve replacement, or both were performed concomitantly in 19 patients. RESULTS: Hospital mortality was 6.5% (3 patients). Morbidity included reoperation for bleeding (17%), mechanical ventilation for more than 72 hours (42%), temporary tracheostomy (13%), and temporary renal dialysis (9%). No patient sustained a stroke. There have been 5 late deaths (3, 18, 34, 51, and 79 months postoperatively) unrelated to the aortic disease. Four patients have undergone successful reoperation on the aorta (false aneurysm [n = 1], endocarditis [n = 1], and progression of disease [n = 2]). Five-year survival was 75%. CONCLUSION: The single-stage, arch-first technique is a safe and suitable alternative to the 2-stage procedure for repair of extensive thoracic aortic disease. |
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Authors:
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Nicholas T Kouchoukos; Michael C Mauney; Paolo Masetti; Catherine F Castner |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 128 ISSN: 0022-5223 ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2004 Nov |
Date Detail:
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Created Date: 2004-10-29 Completed Date: 2005-02-03 Revised Date: 2005-06-20 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 669-76 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiovascular and Thoracic Surgery, Missouti Baptist Medical Center, 3009 N. Ballas Road, St. Louis, MO, USA. ntkouch@aol.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aneurysm, Dissecting / mortality, surgery Aorta / surgery Aortic Aneurysm, Thoracic / mortality, surgery* Blood Vessel Prosthesis Implantation / methods, mortality Cardiovascular Surgical Procedures / methods*, mortality Female Hospital Mortality Humans Male Middle Aged Survival Analysis Thoracotomy / methods, mortality Treatment Outcome |
| Comments/Corrections | |
Comment In:
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J Thorac Cardiovasc Surg. 2005 May;129(5):1206-7; author reply 1207
[PMID:
15867823
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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