ANEURYSMS OF THE ASCENDING AORTA AND TRANSVERSE ARCH - SURGICAL EXPERIENCE IN 80 PATIENTS

  • 1 January 1982
    • journal article
    • research article
    • Vol. 83  (5) , 701-710
Abstract
Aneurysms of the ascending aorta and transverse arch constitute formidable surgical challenges. To assess the impact of surgical techniques on operative morbidity and mortality and late results, 80 consecutive patients operated upon from 1976 through 1980 were reviewed. Average age was 52 yr and 81% were male. The operative mortality was 17.5% (14 deaths). In patients with aneurysm of the ascending aorta, operative deaths were due to cardiac factors (3 patients), neurologic factors (3 patients), cardiac factors (2 patients), and exsanguination (1 patient) accounted for the 6 operative deaths in patients with transverse arch aneurysms. Two late neurologic deaths occurred in this group. Annuloaortic ectasia is best treated by insertion of a conduit with reimplantation of coronary ostia. Dissections are optimally managed by Dacron graft insertion in the ascending aorta and valve replacement. Aortic valve resuspension was done in 6 patients, with 3 undergoing subsequent aortic valve replacement for insufficiency. Aneurysms of the transverse arch treated with profound hypothermia and circulatory arrest were associated with fewer neurologic complications, and the operations were more expeditiously completed. Eleven of 80 patients (14%) had or subsequently needed additional surgical procedures on the aortic valve (insufficiency) or the distal aorta.