DeBAKEy CARDIOvASCuLAR JOuRNAL - Methodist Hospital

15
12
9
6
3
0
10
1
9%
1965-1975
Cases 11
Figure 48. Thoracoabdominal aneurysms
7
2
22%
1976-1985
Cases 9
Figure 46.
Patient status post
CABG with acute
type II dissection
with rupture 35 into
the right ventricle
with fistula. 25
5
Resection of
type II dissection
and replacement
of ascending aorta
with Dacron graft,
reimplantation of
venous bypass
grafts, and closure
of the fistula to the
right ventricle.
Thoracic Aneurysms
Descending thoracic aortic aneurysms accounted for
a lesser number of aneurysms in this patient population,
with 142 operated on in this series. Of this number,
37 patients underwent surgery for acute dissection
either because of rupture or acute expansion. In those
patients operated on for a non-dissecting aortic aneurysm
(105), the average mortality rate over the four
decades was 14.2% — ranging from 2.6% in the second
decade to 31.2% in the first decade (Figure 47).
For those operated on for acute dissection of the
descending thoracic aorta (37), the 30-day operative
mortality ranged from 9–23.5% for the first three
decades (Figure 48). There were none performed in
the fourth decade, partly due to the development of
endovascular interventional techniques with graft
13
4
23.5%
1986-1995
Cases 17
Dissecting descending aneurysms = 37
OP survival = 30
OP death = 7 18.9%
15
0
0%
1996-2005
Cases 0
Figure 47. Thoracic aneurysms
Figure 49.
Type III dissecting aneurysm
of the descending thoracic
aorta with post operative
reconstruction utilizing a
Dacron graft.
placement. An example of a type-three dissecting
aneurysm of the descending thoracic aorta is seen in
Figure 49.
Thoracoabdominal Aneurysms
Thoracoabdominal aneurysms present the most
challenging aspects of aortic surgery. Few surgeons
were inclined to make them a routine practice until
E. Stanley Crawford at Baylor College of Medicine
refined the technical aspects to yield a marked
reduction in mortality and spinal cord paralysis. He
publicized his principles in his book, Diseases of the
Aorta. 1 312
There were 122 patients operated on for thoracoabdominal
aneurysms in Dr. Howell’s 40-year
series, with the majority performed during the last
decade. The mortality and morbidity for this operation
has continued to decline (Figure 50). An example
of a thoracoabdominal aneurysm reconstruction is
seen in Figure 51.
MDCvJ | vII (1) 2011 15
40
30
20
10
0
22
10
31%
1965-1975
Cases 32
37
1
2.6%
1976-1985
Cases 38
Descending aneurysms = 105
OP survival = 90
OP death = 15 14.2%
24
2
7.6%
1986-1995
Cases 26
7
2
22%
1996-2005
Cases 9