Replacement of the descending aorta: recent outcomes of open surgery performed with partial cardiopulmonary bypass.

Objective: Surgical replacement is our standard treatment for descending aortic aneurysm, despite the advent of thoracic endoprostheses. We retrospectively analyzed outcomes of descending aortic replacement performed with partial cardiopulmonary bypass.

Methods: Since 1994, a total of 113 patients in our institution (mean age 68 +/- 12 years, n = 75 male) have undergone graft replacement of the descending aorta for nondissecting aneurysm. There were 16 emergency cases (14.2%). All operations were performed through left thoracotomy with partial cardiopulmonary bypass with segmental clamping. Since 1998, preoperative magnetic resonance angiography has been performed to detect the Adamkiewicz artery in elective cases. Motor evoked potentials are now measured intraoperatively.

Results: Early mortalities were 5.3% overall (6/113), 1.0% (1/97) in elective cases, and 31.3% (5/16) in emergency cases. Rates of spinal cord dysfunction were 2.7% overall (3/113), 1.0% (1/97) in elective cases, and 12.5% (2/16) in emergency cases. Stroke rates were 7.1% overall (8/113), 4.1% (4/97) in elective cases, and 25.0% (4/16) in emergency cases. Rates of respiratory failure were 9.7% overall (11/113), 9.2% (9/97) in elective cases, and 12.5% (2/16) in emergency cases. No patient underwent reoperation for the same lesion as a result of repair problems in the follow-up period. Kaplan-Meier overall survival estimates were 92.2% at 3 years, 90.6% at 5 years, and 70.2% at 10 years.

Conclusion: Although it is more invasive than stent graft repair, descending aorta replacement performed with partial cardiopulmonary bypass involves a risk comparable to that associated with thoracic endoprosthesis placement.