Recent advancement of surgical treatment of aneurysms of the thoracic aorta]

The recent advancement of surgical treatment for aneurysms of the thoracic aorta with special reference to the operative technique and adjunctive methods of distal aortic perfusion during aortic cross-clamping were reviewed. Between 1960 and July, 1991, 415 patients underwent operation for aneurysms of the thoracic aorta in our institution. The overall early mortality rates were 7.7% for the nonruptured aneurysms and 30.6% for the ruptured aneurysms during the last 10 years with recent establishment of mechanical adjuncts and refinement of operative technique. Composite graft replacement with coronary reimplantation was employed in the treatment of annuloaortic ectasia. Selective cerebral perfusion (SCP) with an open aortic anastomosis is a useful adjunct in the treatment for aneurysms of the aortic arch. Graft inclusion technique (Crawford's method) with the aid of a partial bypass is a valid technique for the treatment of thoracoabdominal aortic aneurysms involving visceral branches. Emergency operation is necessary for acute type A aortic dissection to prevent the sudden death due to cardiac tamponade. Acute aortic arch dissection can be treated surgically by replacing both the ascending aorta and aortic arch with prosthetic graft using SCP and open aortic anastomosis. Because of poor prognosis of the aneurysms of the thoracic aorta, and improvement in present surgical results, it now seems justifiable to support an aggressive surgical approach to this disease, before the fatal rupture occurred.