Hypothermic bypass and XXXX for operations on the descending thoracic and thoracoabdominal aorta.

@entity1 @entity63 @entity1746 @entity177 @entity196 @entity439 @entity432 @entity1167 @entity2333 @entity451 @entity1580 @entity2332
BACKGROUND: Hypothermic cardiopulmonary bypass with intervals of @entity1167 is a useful adjunct during operations on the descending thoracic aorta and distal aortic arch when severe @entity2333 precludes placement of clamps on the aorta. @entity2332 also has a marked protective effect on spinal cord function during periods of @entity432 . METHODS: Fifty-one @entity1 (age range, 22 to 79 years) with descending @entity2333 had resection and graft replacement of the diseased aortic segments using hypothermic cardiopulmonary bypass and intervals of @entity1167 in situations where the location, extent, or severity of disease precluded placement of clamps on the proximal aorta (8 @entity1 ) or (in 43 @entity1 ) when extensive thoracic (11) or thoracoabdominal (32) @entity2333 was present and the risk for development of spinal cord @entity63 and @entity177 was judged to be increased. Patent intercostal (below T-6) and @entity432 were attached to the graft whenever possible. RESULTS: Thirty-day mortality was 9.8% (5 @entity1 ). @entity451 occurred in 2 and @entity1746 in 1 of the 46 30-day survivors (6.5%). Among the 27 operative survivors with @entity439 , @entity451 occurred in 1 of 12 with @entity196 (8%), 0 of 10 with type II, and 1 of 5 with @entity439 (20%). @entity451 occurred in none of the 12 @entity1 with @entity1580 and in 2 of the 15 @entity1 with @entity439 . @entity177 requiring dialysis occurred in 1 (2.2%) of the 46 30-day survivors. CONCLUSIONS: Hypothermic @entity1167 is a valuable adjunct for the treatment of complex @entity2333 involving the aortic arch and thoracoabdominal aorta. In @entity1 with @entity439 , its use has been associated with a low incidence of @entity177 and an incidence of @entity451 / @entity1746 in traditionally high-risk subsets (type I and II @entity439 , @entity1580 ), which may be less than that observed with other surgical techniques.
