Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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The Thracoabdominal Aortic Replacement Using Deep Hypothermic Circulatory Arrest Technique

흉복부대동맥치환술에서 극저체온하순환정지법의 효과

  • Woo, Jong-Su (Department of Thoracic & Cardiovascular Surgery, College of Medicine, Dong A University) ;
  • Bang, Jung-Hee (Department of Thoracic & Cardiovascular Surgery, College of Medicine, Dong A University) ;
  • Kim, Si-Ho (Department of Thoracic & Cardiovascular Surgery, College of Medicine, Dong A University) ;
  • Choi, Pil-Jo (Department of Thoracic & Cardiovascular Surgery, College of Medicine, Dong A University) ;
  • Cho, Kwang-Jo (Department of Thoracic & Cardiovascular Surgery, College of Medicine, Dong A University)
  • 우종수 (동아대학교 의과대학 흉부외과학교실) ;
  • 방정희 (동아대학교 의과대학 흉부외과학교실) ;
  • 김시호 (동아대학교 의과대학 흉부외과학교실) ;
  • 최필조 (동아대학교 의과대학 흉부외과학교실) ;
  • 조광조 (동아대학교 의과대학 흉부외과학교실)
  • Published : 2006.03.01
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Abstract

Background: Thoracoabdominal aortic replacement is an extensive operation that opens both the pleural cavity and abdominal cavity, which has high mortality and morbidity rate. The authors have reported 9 cases of the thoracoabdominal aortic replacement in 2001. Since 2003 we have applied the deep hypothermic circulatory arrest to the Crawford type I and II thoracoabdominal aortic replacement. Therefore, we analysed the effect of the changes in operative techniques. Material and Method: Between 1996 and 2005, we have performed 20 cases of thoracoabdominal aortic replacement. The underlying diseases were 8 cases of atherosclerotic aneurysm with 4 cases of ruptured aneurysm and 12 cases of aortic dissection with 10 cases of a previous operations. According to Crawford classification, there were 2 cases of type I, 7 cases of type II, 1 case of type III, 7 cases of type IV, and 3 cases of type V. We compaired the results of the patients who underwent thoracoabdmoninal replacement before 2001 which already has been reported and after then. Result: Before 2001 we have performed 9 cases of thoracoabdominal replacement and 5 patients were died of the operation. All three patients with type I and II were died. There was no case of thoracoabdominal replacement between 2001 and 2002, but after 2003 we have performed 11 cases of thoracoabdominal replacement which involved 1 case of type I, 5 cases of type II, 1 case of type III, 2 cases of type IV and 2 cases of type V. There was no mortality and no fetal complications. Conclusion: The deep hypothermic circulatory arrest is a safe method of extended thoracoabdominal aortic replacement.

배경: 흉복부대동맥치환술은 흉강과 복강 및 횡격막의 절개가 필요한 광범위한 수술로 수술합병증과 사망률이 높은 질환으로 알려져 있다. 본 교실에서 2001년까지의 성적은 이미 보고한 바 있었으나 그 후 극저체온하 순환정지법을 사용하여 좋은 결과를 얻었기에 비교하여 보고하고자 한다. 대상 및 방법: 96년에서 2005년 8월까지 흉복부대동맥치환술을 20명의 환자에서 시행하였다. 원인질환은 동맥경화성흉복부대동맥류가 8예, 박리성흉복부대동맥류가 12예였다. 치환범위로는 Crawford분류법으로 I형이 2예, II형이 7예, III형이 1예, IV형이 7예, V형이 3예였다. 이들의 결과를 이미 보고한 시점인 2001년을 기준으로 구분하여 비교하였다. 걸과: 2001년 이전에 수술한 흉복부대동맥치환술 환자 9명중에 5명이 사망하였는데 type I, II의 3명은 모두 사망하였었다. 그 후에는 기존의 방법을 바꾸어 Crawford type I, II의 광범위 흉복부치환술 6명에서 극저체온하순환정지법을 사용하고, type III, IV, V의 국소 흉복부 치환술 5명에서 대퇴동정맥체외순환으로 적극적인 늑간동맥문합을 시행한 결과 11 명 모두에서 허혈성 합병증 없이 모두 치료되어 외래 경과 추적 중이다. 결론: 극저체온하 순환정지법은 광범위 흉복부대동맥을 안전하게 치환하게 하는 수기이다.

Keywords

References

  1. Cho KJ, Woo JS, Sung SC, Choi PJ. The clinical experience of the descending thoracic and thoracoabdominal aortic surgery. Korean J Thorac Cardiovasc Surg 2002;35:584-9
  2. Safi HJ, Huynh TTT, Estrera AL, Miller CC. Thoracoabdominal aortic aneurysm. In: Rutherford RB. Vascular surgery. 6th ed. Philadelphia: Elsevier Sauders. 2005;1490-511
  3. Coselli JS, LeMaire SA, Conklin LD, Koksoy C, Schmittling ZC. Morbidity and mortality after extent II thoracoabdominal aortic aneurysm repair. Ann Thorac Surg 2002;73:1107-16 https://doi.org/10.1016/S0003-4975(02)03370-2
  4. Kouchoukos NT, Daily BB, Rokkas CK, Murphy SF, Bauer S, Abboud N. Hypothermic bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta. Ann Thorac Surg 1995;60:67-77 https://doi.org/10.1016/S0003-4975(95)00353-3
  5. Estrera AL, Miller CC, Huynh TTT, Porat E, Safi HJ. Neurologic outcome after thoracic and thoracoabdominal aortic aneurysm repair. Ann Thorac Surg 2001;72:1225-31 https://doi.org/10.1016/S0003-4975(01)02971-X
  6. Schepens M, Dossche K, Morshuis W, et al. Introduction of adjuncts and their influence on changing results in 402 consecutive thoracoabdominal aortic aneurysm repairs. Eur J Cardiothorac Surg 2004;25:701-7 https://doi.org/10.1016/j.ejcts.2004.01.033
  7. Kouchoukos NT, Masetti P, Rokkas CK, Murphy SF. Hypothermic cardiopulmonary bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta. Ann Thorac Surg 2002;74:1885-7 https://doi.org/10.1016/S0003-4975(02)04153-X
  8. Carrel TP, Berdat PA, Robe J, et al. Outcome of thoracoabdominal aortic operations using deep hypothermia and distal exsanguination. Ann Thorac Surg 2000;69:692-5 https://doi.org/10.1016/S0003-4975(99)01542-8
  9. Kouchoukos NT, Masetti P, Rokkas CK, Murphy SF, Blackstone EH. Safety and efficacy of hypothermic cardiovpulmonary bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta. Ann Thorac Surg 2001;72:699-708 https://doi.org/10.1016/S0003-4975(01)02800-4
  10. Kouchoukos NT, Rokkas CK. Hypothermic cardiopulmonary by pass for spinal cord protection: Rationale and clinical results. Ann Thorac Surg 1999;67:1940-2 https://doi.org/10.1016/S0003-4975(99)00442-7
  11. Maniar HS, Sundt TM, Prasad SM, et al. Delayed paraplegia after thoracic and thoracoabdominal aneurysm repair: a continuing risk. Ann Thorac Surg 2003;75:113-20 https://doi.org/10.1016/S0003-4975(02)04494-6