Thoracic and thoracoabdominal aortic aneurysm repair using cardiopulmonary bypass, profound hypothermia, and XXXX via left side of the chest incision.

@entity1 @entity712 @entity64 @entity101 @entity954 @entity3665 @entity75 @entity1614 @entity1514 @entity177 @entity358 @entity1167 @entity204 @entity1580
PURPOSE: Although some authors advocate hypothermic @entity1167 for spinal cord protection in descending @entity1514 and thoracoabdominal repair, this method has been associated with high morbidity and mortality rates in other studies. The safety and effectiveness of this surgical adjunct were evaluated. METHODS: Between February 1991 and April 1997, 409 @entity1 underwent @entity1514 or thoracoabdominal aortic repair. Because of an inability to gain proximal aortic control because of anatomic or technical difficulty, hypothermic @entity1167 was used in 21 @entity1 (4.9%). Thirteen @entity1 were @entity1 , 8 were @entity1 , and the median age was 57 (range, 21 to 81 years). Four @entity1 (19%) had @entity1614 , and 1 had @entity3665 . Seven @entity1 (33%) had @entity1580 (4 chronic type A, 2 chronic type B, 1 acute B), and 1 had aortic laceration. All but 6 @entity1 had @entity101 . Fifteen @entity1 (73%) were operated on for repair of the distal arch and descending @entity1514 aorta, 4 (19%) for repair of the distal arch and thoracoabdominal aorta, and 2 for repair of either the thoracoabdominal or descending @entity1514 aorta alone. Surgery for 9 @entity1 (43%) also included bypass grafts to the subclavian or innominate arteries. Six operations (29%) were urgent. RESULTS: The overall 30-day mortality rate was 29% (6 of 21 @entity1 ). Among urgent @entity1 , the mortality rate was 50% (3 of 6 @entity1 ) versus 20% (3 of 15) for elective @entity1 . Of the remaining 15 @entity1 , @entity177 occurred in 1 (7%) and @entity712 in 2 (13%). Ten @entity1 (67%) had @entity358 . @entity75 occurred in 5 @entity1 (33%) and @entity64 in 2 (13%), and spinal cord neurologic deficit developed in 2 (13%). The median recovery was 28 days (range, 10 to 157 days). CONCLUSION: Hypothermic @entity1167 did not reduce the incidence of @entity204 and morbidity to a rate comparable with our conventional methods. We recommend the judicious application of this method in rare instances when proximal control is not feasible or catastrophic @entity954 leave the surgeon with no other option.
