Background: Replacement of the thoracic aorta is associated with high mortality and morbidity rates. We evaluated early results of descending aortic replacement and the factors affecting these results.

Methods: The study included 28 consecutive patients (24 males, 4 females; mean age 55±13 years; range 23 to 76 years) who underwent descending thoracic aortic replacement. The underlying pathologies were acute type B dissection (n=12, 42.9%), degenerative aneurysm (n=11, 39.3%), dissecting aneurysm (n=3, 10.7%), and aortic transsection (n=2, 7.1%). Nineteen patients (67.9%) underwent emergency surgery, while nine patients (32.1%) were operated on electively. Indications for emergent operation were rupture (n=12, 63.1%), persistent pain (n=3, 15.8%), malperfusion (n=2, 10.5%), and aortic transsection (n=2). Left atriofemoral bypass was used in 18 patients (64.3%), and simple aortic clamping was used in 10 patients (35.7%). Cerebrospinal fluid drainage was performed in nine patients (32.1%).

Results: The mean length of hospital stay was 16±9 days. In-hospital mortality occurred in four patients (14.3%). Complications in the remaining patients were prolonged mechanical ventilation (n=3, 12.5%), wound site infection (n=3), pneumonia (n=2, 8.3%), and individually, gastrointestinal system hemorrhage, hoarseness, prolonged air leak, and atrial fibrillation. Revision was required in only one patient with wound site infection. Paraplegia or paraesthesia was detected in three patients (10.7%), of which two were operated on with simple aortic clamping, one with left atriofemoral bypass, and one with cerebrospinal fluid drainage. No significant correlation was found between operative variables and mortality or morbidity. It was noted that, albeit insignificant, the frequency of paraplegia was higher in the absence of cerebrospinal fluid drainage.

Conclusion: Based on our experience, left atriofemoral bypass and cerebrospinal fluid drainage have somewhat favorable effects on mortality and morbidity even though this observation was not favored by statistical strength.

Keywords : Aortic aneurysm, thoracic/surgery; cerebrospinal fluid pressure; drainage; paraparesis; paraplegia; spinal cord injuries.