Z.Mitrev1, T. T. Angusheva 1, N.Hristov1, E Stoicoski1, E. Idoski 1, A. Mtvejcuk 2
1Special Hospital for Surgery “Filip Vtori”; 2MORF 3 CVKG im.A.A.Vishnevskogo (Krasnogorsk, Russia);
Background:Hemorrhagic shock, cardiac arrest and multisystem organ failures are the most frequent causes of death, and paraplegia and renal failure are the most devastating complications, there why surgery for thoracoabdominal aneurysm is a real chalenge.
Material:
During last 6years, 26 patients with thoracoabdominal aneurysm had been operated. All were men, age 55 ± 7y ,symptomatic,with mean aneurysm dimension of 10 ± 2 centimeters.12 patients had ongoing rupture(Crawford III).6 patient had Crawford type IV, and 8 patients had ongoing rupture for Crawford type I with aneurysm(aortic arch).Emergency surgery was performed in all patients through thoracophrenolaparotomy.
Results:
There were no operative deaths. All patients remained hemodinamically stable throughout the procedure. Seven patients had minimal blood loss postoperatively and were extubated within first 24 hours. They had uneventful postoperative stay and were released home on the 8-th and 10-th postoperative day.4patients required prolonged ventilation and postoperative use of cell saver.Patient who had previous laparotomy developed infection of the surgical incision that required surgical reintervention.Graft infection was prevented, and following successful vacuum assisted treatment, patient was discharged home on the 56-th postoperative day. Patient who was reoperated for aneurysm of the arch and Crawford type I had prolonged postoperative recovery with prolonged ventilation, tracheostomy, intestinal bleeding, sepsis and paraplegia.He died after 7 months.Mortality rate was 7,6% (2pts)
Conclusion:
Without the use of extracorporal circulation and reduced ischemic time during TAA repair,this technique avoids the inevitable operative complications encountered with hypothermic circulatory arrest, partial cardiopulmonary bypass, partial left heart bypass, or clamp-and-sew strategy.
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