XXXX of the descending thoracic aorta: three hundred sixty-six consecutive cases resected without paraplegia.

@entity1 @entity8 @entity602 @entity30726 @entity177 @entity439 @entity1756
PURPOSE: The aim of this study was to present a 20-year experience with a single method of passive distal perfusion during descending thoracic aortic @entity439 resection. METHODS: Aortic repair with a Dacron graft interposition was performed for 366 consecutive @entity439 located between the left subclavian artery and the crux of the diaphragm. The extent of aorta resected in 335 @entity1 (91.5%) represented one third or less of the aortic length. @entity30726 mm Gott shunt was cannulated proximally into the ascending aorta (235 cases), the aortic arch (60 cases), the descending aorta (68 cases), or the left ventricle (3 cases) and inserted distally into the descending aorta (232 cases), the femoral artery (127 cases), or the abdominal aorta (7 cases). Shunt flows were recorded in 91 cases and varied from 1100 ml to 4900 ml/min, (mean 2526 ml/min). Distal pressure during shunting was measured in 62 @entity1 . It varied from 15 to 120 mm Hg (mean 64.5 mm Hg). The aortic cross-clamp time varied from 8 to 124 minutes (mean 30 minutes). RESULTS: The hospital death rate was 12% overall and 9.9% (35/351) if @entity1756 are excluded. Among 359 operating room survivors, neither immediate nor delayed ischemic @entity602 occurred. Transient @entity8 occurred in nine @entity1 (2.4%) and @entity177 in one (0.2%). Five deaths (1.3%) were shunt related. CONCLUSION: Distal perfusion with the 9 mm Gott shunt has proven to be an effective method to preserve spinal cord function. The limited extent of aorta resected and the brief aortic cross-clamp time may also be interactive factors of protection.
