The clinical research of different surgical strategies in total thoracoabdominal aortic aneurysm repair
10.3760/cma.j.issn.1001-4497.2012.02.002
- VernacularTitle:不同手术方式行全胸腹主动脉替换的临床研究
- Author:
Ming ZHANG
;
Lizhong SUN
;
Yongmin LIU
;
Junming ZHU
;
Jun ZHENG
;
Tao BAI
;
Lijian CHENG
;
Xiaoyan XING
;
Hao WAN
- Publication Type:Journal Article
- Keywords:
Aortic aneurysm;
Cardiac Surgical procedures;
Thoracoabdominal aortic aneurysm repair
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2012;28(2):68-71
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the safety and feasibility of performing total thoracoabdominal aortic aneurysm repair (tTAAAR) under normal thermia and non-cardiopulmonary bypass fashion by comparing surgical indications and details of different surgical strategies in tTAAAR.Methods From February 2009 to May 2011,46 consecutive patients with extensive Crawford Ⅱ thoracoabdominal aortic aneurysm (TAAA)underwent total thoracoabdominal aortic aneurysm repair( tTAAAR ) in An Zhen Hospital.The patients were divided into 2 groups ( A and B) according to their different surgical strategies.Patients in group A underwent total thoracoabdominal aortic aneurysm repair with deep hypothermia and circulatory arrest.Patients in group B underwent total thoracoabdominal aortic aneurysm repair in a normal thermia and non-circulatory bypass was performed via a combined left thoracoabdominal incision.After established the bypass from descending aorta to bilateral iliac arteries under normal thermia,the reestablishment of intercostal arteries and visceral arteries was followed with subsection circulatory arrest.The clinical results of these 2 groups were analyzed by SPSS 18.0.Results Patients in group A underwent total thoracoabdominal aortic aneurysm repair with deep hypothermia and circulatory arrest have higher mortality rate and transient nervous dysfunction rate (26.67％ vs 3.20％,P =0.033 ; 33.30％ vs 3.30％,P =0.018,respectively) than patients in group B underwent total thoracoabdominal aortic aneurysm repair in a normal thermia and non-circulatory bypass.Statistical significance was also observed between group A and circulatory arrest and group B in operation time,descending aortic clamping time,and transfusiori volume of red blood cells ( P ＜ 0.05 ).Average age,sex,pathological type,the maximal diameters of aneurysm,preoperative complications,visceral ischemia time,spinal cord ischemia time,ICU treatment time,intubation time,respiratory complications,plasma dosage,platelets dosage,RBC dosage,thoracotomy hemostatic,spinal cord injury,renal insufficiency were found no statistical significance(P ＞ 0.05 ) between two groups.In addition to death and paraplegia,the others were cured.Conclusion The normal thermia and non-cardiopulmonary bypass tTAAAR is a safe and feasible therapeutic strategy for TAAA patients.A bypass from descending aorta to iliac arteries can be built under normal thermia in TAAA patients,which is the indication of this new technique.Reestablishment of intercostal arteries is an important protective adjunct to avoid spinal cord injury.
