The Analysis For The Relative Factors Of Leading To Massive Hemorrhage, Cerebral Injury And Paraplegia During The Period Of The Surgical Management Of Thoracic Aneurysms And Surgical Management Strategy For Thoracic Aortic Aneurysms

Objective: To summarize the experience of the surgical management of thoracic aortic aneurysms, analyses the relative factors of leading to massive hemorrhage, cerebral injury and paraplegia during the period of the surgical management of Thoracic Aneurysms and make surgical management strategy for thoracic aortic aneurysms.Methods: Seventy-two patients suffering from the thoracic aortic aneurysm (58 males, 14 females, mean age 46.24?3.10 years) were enrolled in our study. Those patients suffered from the disease for 8 hours to 6 months before they hospitalized. All of the thoracic aortic aneurysms were diagnosed through two or more of UCG, DSA, CT and MRI. The etiology included aortic dissection in 32 cases, which comprised DeBakey type I in 16 cases, DeBakey type II in 7 cases, and DeBakey type III in 9 cases, atherosclerotic ascending aortic aneurysm in 19 cases, Marfan syndrome in 16 cases, and descending aortic aneurysm in 5 cases. The associated diseases were severe aortic insufficiency in 24 cases, aortic stenosis in 4 cases, aortic valve prolapse in 2 cases, severe tricuspid insufficiency in 4, mitral prolapse in 2, mitral stenosis in 1. severe tricuspid insufficiency in 5, Ebstein's anomaly in 2, patent ductus arteriosus in 2, pulmonary hypertension in 2, and hydropericardia in 1. Other'associated diseases included coronary heart disease in 4 cases, and acute renal failure in 3 patients.The procedures of all the aortic arch and some ascending aortic aneurysms were performed under deep hypothermic circulation, and 12 cases were performed under DHCA and retrograde cerebral perfusion (RCP). Bentall procedures were performed in 44 cases, which were associated with mitral valve replacement in 4, cardiac artery bypass graft in 3 cases, mitral valve-plasty in 3 cases, the correction of tricuspid , anomaly in 3, and replacement of semi-aortic arch in one respectively.David's procedures were performed in 9 cases, which were associated with total aortic arch replacement in 3 cases. Ascending aortic replacement was performed in 6 cases, which were associated with CABG in 3 cases, total aortic arch replacement in 2 cases, proximal semi-aortic arch replacement in 2 cases and ligation of PDA respectively. Descending aortic replacement was performed in 11 cases, and descending aortic repair were done in 1. In the semi-aortic replacement of four cases, two of them were performed with David's operation, one was performed with Bentall operation; there was only one case who was performed with isolated semi-aortic replacement. Total aortic arch replacement was performed in eight cases, and five of them were performed with David's operation, but the others were performed solely. Result: Sixty-three patients of this group were cured. Immediately after the operations, there were two patients to undergo the second hemostasis procedure due to postoperative hemorrhage. There was one patient who died from the refractory ventricle fibrillation immediately after the Bentali operation before releasing the cardiopulmonary bypass. Seven patients, postoperatively, suffered from transient unconsciousness, whereas they recovered soon from the fourth day to the fifteenth day after operation respectively. Three patients died from the cerebral injury postoperatively. All the cases were followed up during 3 months to eleven years (mean sixty-three months). All the patients had lived quite well without any late-term infectious bacterial endocarditis, anastomotic pseudoaneurysm, aortic dissection, aortic insufficiency and peri-aortic valve leakage.Conclusion: Because of its special complicated anatomic location and pathophysiological characteristics, and complex and demanding surgical procedures, the patients with thoracic aneurysms undergoing surgical management usually have high perioperative mortality rate owing to massive hemorrhage, cerebral injury and paraplegia. This scientific research indicates that it will be effective to utilize multiple procedures to reduce the surgical complications and modify its effects as follow...