Surgical treatment of thoracic and thoracoabdominal aortic aneurysms: Experience with left atriofemoral bypass

Background. The aim of this study was to analyse perioperative morbidity and mortality in patients undergoing thoracic (TAA) and thoracoabdominal aortic aneurysm (TAAA) surgery at the Department of Vascular Surgery of IRCCS San Raffaele, Milan. Methods. The study included 258 patients (199 males and 59 females) with a mean age of 66 (range: 41-82 years) undergoing 259 operations for aneurysmectomy of TAA or TAAA between January 1988 and April 2000. Cerebral spinal fluid drainage (CSFD) was used in 166 cases (75% of TAAA, 53% of TAA; 183 patients (98 TAAA and 85 TAA) were operated on with the use of left atriofemoral bypass using a Biomedicus pump. Results. The overall mortality rate at 30 days was 33/259 (13%); a total of 26 deaths (11%) were recorded during elective surgery and 7 (32%) in patients undergoing emergency repairs. The following perioperative complications were reported: paraplegia/paraparesis in 20 cases (8%), respiratory failure requiring prolonged intubation in 62 cases (24%), cardiac complications (major arrhythmia, myocardial infarction) in 26 cases (10%), renal failure in 18 cases (7%), postoperative bleeding requiring redo surgery in 12 cases (5%), graft infection in 5 cases (2%). Conclusions. Morbidity and mortality consequent to TAAA and TAA surgery are still high. However, based on our experience, the use of atriodistal bypass, sequential cross-clamping and CFSD enables acceptable results to be achieved and reduces complications secondary to spinal cord and visceral ischemia without the need for expeditious clamping times.