You are here

Article Text

Article menu
Download PDFPDF
Editorial
Open surgery for thoracic aortic disease
  1. H J Safi1,
  2. P R Taylor2
  1. 1Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, Memorial Hermann Hospital, Houston, Texas, USA
  2. 2Department of General and Vascular Surgery, Guy’s & St Thomas’ Hospital, London, UK
  1. Correspondence to:
    Mr Peter Taylor, Department of General and Vascular Surgery, Guy’s & St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH, UK;
    taylorvasc{at}aol.com

https://doi.org/10.1136/heart.89.8.825

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    While new technologies appear to offer potential advantages over traditional therapies for thoracic aortic disease, open surgery is still the mainstay of treatment for the overwhelming majority of patients

    Many recent technical advances have enhanced the safety of open surgery of the descending thoracic aorta. Previous to the refinement of these adjuncts and techniques, surgeons such as Stanley Crawford showed that simple aortic cross-clamping with expeditious surgery produced the best results.1 In Crawford’s era of “clamp and go”, time limitations pressured surgeons to perform anastomoses rapidly with perfect haemostasis. The duration of aortic cross-clamping was directly related to survival and to serious complications such as paraplegia and visceral ischaemia. The role of bypass, intercostal reimplantation, and cerebrospinal fluid drainage was unclear, in that none of these techniques appeared to be beneficial.

    Cross-clamping the aorta below the left common carotid artery and above the coeliac axis increases proximal systemic pressure, which in turn increases the cerebrospinal fluid pressure. In addition, the mean arterial pressure distal to the clamp will fall, and therefore the distal spinal cord will be at risk of ischaemia from a combination of decreased arterial perfusion and increased cerebrospinal fluid pressure. Logically, techniques that help to reduce the cerebrospinal fluid pressure and increase the distal arterial pressure will help to treat these two adverse factors, and will consequently lower the incidence of paraplegia.

    Cerebrospinal fluid drainage prevents elevation of the cerebrospinal fluid pressure, and several techniques can increase the distal arterial perfusion pressure, such as a simple shunt, partial heart bypass (from the left atrium or the pulmonary veins to the left …

    View Full Text