Staged repair of extensive aortic aneurysm: Improved neurologic outcome

Objective We reviewed the adjuncts for brain and spinal cord protection and modifications of operative techniques. Summary Background Data Two-staged repair-the ''elephant trunk'' technique-has provided the means for successful repair of massive aortic aneurysms, although historically morbidity has been high. Methods Between February 1991 and February 1996, we operated on 512 patients for thoracic aortic aneurysm. Preoperative, intraoperative, or postoperative predictors of morbid outcomes were studied in 63 patients treated with the elephant trunk technique. Data were analyzed by contingency table methods. Results After stage 1, there were no strokes among patients who received retrograde cerebral perfusion (0 of 53), two strokes occurred among patients who did not receive retrograde cerebral perfusion (2 of 10 [20%]), and early mortality occurred in 4 of the 63 patients (6%). Interval mortality occurred in 6 of 59 patients (10%); 3 (50%) of these 6 deaths were due to distal aortic aneurysm rupture. Thirty-eight patients have undergone stage two repair thus far. There was no incidence of neurologic deficit after stage 2, and early mortality occurred in 1 of the 38 patients (3%). Conclusions Extensive aortic aneurysm can be successfully treated using the elephant trunk technique. in this group of patients, retrograde cerebral perfusion eliminated neurologic complications.