Stroke in surgery of the arteriosclerotic descending thoracic aortic aneurysms: influence of cross-clamping technique of the aorta.
Aneurysms of the descending thoracic aorta are usually treated under simple cross-clamping of the aorta. A shunt or partial bypass may be used to protect the heart and to maintain the distal circulation. However, situations exist where repair is only feasible using deep hypothermic circulatory arrest (DHCA). The aim of this retrospective study is to describe the technique of DHCA through a left posterolateral thoracotomy and to assess conditions in which this technique can be used. Fifteen patients with proximal descending thoracic aneurysms were treated using DHCA through a left posterolateral thoracotomy. Most of the interventions were urgent. The decision to use DHCA was made intraoperatively in 86% of the patients and was based mainly on local, unforeseen conditions. Early mortality was 13.3%, no late mortality was observed. The most frequent complications were respiratory (20%) and renal (13.3%). Paraplegia or other neurologic disorders, temporary or permanent, were not encountered. Deep hypothermic circulatory arrest is a helpful tool in the management of difficult descending thoracic aorta aneurysms through a left posterolateral approach. In cases where simple cross-clamping of the aorta is not possible, this technique offers a reliable alternative with acceptable morbidity and mortality.