Surgical Treatment of Descending Aortic Aneurysms - Bypass, Shunting, or Simple Aortic Clamping -

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We have reviewed our experience of resection of 48 aneurysms of the descending thoracic aorta during the past 2 decades. There were 11 atherosclerotic aneurysms, 34 aneurysms associated with aortic dissection, and 3 posttraumatic aneurysms. During repair, a temporary shunt was used in 26 patients (54%), partial (femorofemoral) cardiopulmonary hypass (CPB) in 10 patients (21%), and simple aortic cross-clamping in 12 patients (25%). For the group with a temporary shunt, 4 out of 17 patients (24%) undergoing emergency operation died, and 1 out of 9 patients (11%) undergoing elective surgery died. The aortic cross-clamping time ranged from 30 to 120 min with a mean of 54 min. For the group with partial cardiopulmonary bypass, 2 out of 4 patients (50%) undergoing elective surgery died; and all of the 6 patients (100%) undergoing emergency operations died. The aortic cross-clamp time ranged from 35 to 162 min with a mean of 99 min. For the group with simple aortic cross-clamping, all of the 6 patients undergoing elective surgery survived, and 2 out of 6 patients (33%) undergoing emergency operation died. The aortic cross-clamping time ranged from 28 to 74 min with a mean of 46 min. Considering the surgical morbidity, mortality and associated risk factors, a shunt procedure appeared to be the method of choice in surgical treatment of descending aortic aneurysm. Under the surveillance of blood pressure in both aortic segments proximal and distal to the aortic occlusion, direct aortic cross-clamping method can be safely applied to those who had adequate collateral perfusion. Bypass with systemic heparinization resulted in intraoperative coagulopathy, thus induced high surgical morbidity and mortality. We would like to confine the technique to those who had a ruptured aneruysm, an extensive aortic dissection or anticipated excessive hemorrhage during tissue dissection.