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The Annals of Thoracic Surgery, Vol 53, 227-232, Copyright © 1992 by The Society of Thoracic Surgeons
J Laas, MJ Jurmann, M Heinemann and HG Borst
From 1980 to January 1991, 130 patients (89 men and 41 women, aged 22 to 76
years; mean age, 52 years) underwent 133 interventions on the aortic arch.
Aneurysm was diagnosed in 57 patients, whereas 29 had chronic and 44 acute
aortic dissection. In 67 instances a partial and in 35 instances a total
arch replacement was performed. The distal arch was approached through a
left thoracotomy in 14 patients. Local interventions (n = 17) included
surgical reconstruction and glue procedures. Additionally, 55 patients
required aortic valve replacement, preferably with composite grafts (n =
46), whereas the valve was reconstructed in 14. Procedures were performed
using hypothermia (nasopharyngeal temperature, 11 degrees to 25 degrees C)
and circulatory arrest (mean time, 27 minutes). Early mortality was 13.9%
at the first operation on the aortic arch. Early deaths included 7 of 57
patients with aortic aneurysm (12.3%), 2 of 29 patients with chronic
dissection (6.9%), and 9 of 44 patients with acute dissection (20.5%).
Neurological (n = 6) and cardiac events (n = 5) were the most common causes
of early death. Since 1987, 7 of 88 patients have died for an overall
mortality of 8.0%. With growing experience, proper indication, and adequate
operative strategy including the use of circulatory arrest in hypothermia,
operation on the aortic arch can be performed with an acceptable risk.
ARTICLES
Advances in aortic arch surgery
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
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