Thoracoabdominal aortic aneurysm repair. Analysis of postoperative morbidity
L. H. Hollier, J. B. Symmonds, P. C. Pairolero, K. J. Cherry, J. W. Hallett and P. Gloviczki
Department of Surgery, Ochsner Clinic, New Orleans, LA 70121.
Between 1980 and 1986, 101 nondissecting thoracoabdominal aortic aneurysms
(TAAAs) were repaired at the Mayo Clinic, Rochester, Minn. Overall
mortality was 15% with a 9.6% mortality for elective repair. Nonfatal
complications occurred in 44% of patients and included myocardial
infarction in 9%, paraplegia in 5%, and renal failure in 4%. In an attempt
to reduce morbidity and mortality associated with TAAA repair, one of our
vascular surgical services set up a routine protocol of preoperative
evaluation, standardized operative technique, and specific guidelines for
perioperative management. Fifty-five of the 101 patients underwent elective
repair on this service without the use of shunts or bypass. Mortality was
reduced to 1.8% and the rate of myocardial infarction was reduced to 1.8%;
none of these patients developed renal failure. However,
paraplegia/paraparesis still occurred in 5.4% and pulmonary insufficiency
occurred in 29%. Preoperative cardiac evaluation and intraoperative
reduction of cardiac afterload are important factors in reducing myocardial
infarction and death associated with TAAA repair and should be integrated
into the management of these patients. However, preexisting pulmonary and
renal disease in some patients may limit the surgeon's ability to reduce
rates of some complications.