Long-term results of patch repair for saccular aneurysms of the transverse aortic arch.

ABSTRACT

OBJECTIVE: Long-term results of patch repair in patients with a saccular aneurysm of the aortic arch were investigated. PATIENTS From December 1984, 43 patients with a saccular aneurysm of the arch underwent patch repair. Indications for patch repair were determined as orifice diameter of aneurysm being less than 1/3 of the total circumference of the aorta. METHOD: Midsternotomy was used in 38 patients, and left thoracotomy in five. Selective cerebral perfusion was used in 28 patients, deep hypothermic circulatory arrest with retrograde cerebral perfusion in eight during the last 3 years, and partial cardiopulmonary bypass in seven. RESULTS: There were five (11.6%) early deaths, and causes were respiratory failure in two patients, low cardiac output in two, and gastrointestinal bleeding in one. Stroke was found in three patients (6.9%). During follow-up, seven patients died, two due to rupture of a residual or pseudoaneurysm, one due to reoperation of pseudoaneurysm, one due to stroke, two due to respiratory failure, and one due to unknown cause. Postoperative survival, including early death, was 69.3% at 5 years and 43.3% at 9 years. Aortic reoperation was done in three patients with a pseudoaneurysm formation and two survived. Freedom from reoperation was 91.7% at 5 years and 38.2% at 9 years. Event free ratio was 79.3 +/- 9.8% at 5 years and 37.6 +/- 18.6% at 9 years. CONCLUSION: Because of a high incidence of pseudoaneurysm or residual aneurysms after patch repair for a saccular aneurysm of the aortic arch, strict criteria for the patch repair should be applied or graft replacement of the aorta is recommended.