Reoperation for aortic false aneurysms: Our experience and strategy for safe resternotomy

Fabrizio Settepani, Mirko Muretti, Alessandro Barbone, Enrico Citterio, Alessandro Eusebio, Diego Ornaghi, Giuseppe Silvaggio, Roberto Gallotti

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Abstract

Background and aim of the study: To review our experience with reoperation for aortic false aneurysms (FA) and to present an analysis of the relevant surgical approaches and risks. Methods: From May 1999 to June 2006, 11 patients underwent a total of 13 reoperations due to aortic false aneurysms, with an incidence of 3% of all thoracic aortic cases. Cardiopulmonary bypass (CPB) and cooling were started before sternotomy in all cases. Three different strategies were adopted for patients depending on the position of the FA in the mediastinum as indicated by a preoperative CT scan. These included: deep hypothermic circulatory arrest (18°C), moderate hypothermia (28°C), and mild hypothermia (32°C). In two patients, the sternotomy ruptured the FA causing profuse hemorrhaging. In all the other cases sternotomy was performed without complication. The repair consisted in simple repair by direct suture (10 cases) or extensive repair by refashioning the anastomosis (three cases). Results: Two hospital deaths occurred with a hospital mortality rate of 16.7%. Permanent neurological deficit developed in one patient. Transient neurological deficit in the form of left lower limb weakness was observed in one patient. False aneurysm recurrence developed in two cases. Among patients present at follow-up (nine survivors), four are in NYHA class I and five in class II. Conclusions: Aortic false aneurysms carry a high mortality and morbidity rate. Nevertheless, we believe that selecting the right strategy according to the position of the FA in the chest can reduce surgical risk, thus permitting relatively safe resternotomy.

Original languageEnglish
Pages (from-to)216-220
Number of pages5
JournalJournal of Cardiac Surgery
Volume23
Issue number3
DOIs
Publication statusPublished - May 2008

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Aortic Aneurysm
False Aneurysm
Reoperation
Sternotomy
Hypothermia
Thorax
Deep Hypothermia Induced Circulatory Arrest
Ruptured Aneurysm
Mortality
Mediastinum
Hospital Mortality
Cardiopulmonary Bypass
Sutures
Survivors
Lower Extremity
Morbidity
Recurrence
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Reoperation for aortic false aneurysms : Our experience and strategy for safe resternotomy. / Settepani, Fabrizio; Muretti, Mirko; Barbone, Alessandro; Citterio, Enrico; Eusebio, Alessandro; Ornaghi, Diego; Silvaggio, Giuseppe; Gallotti, Roberto.

In: Journal of Cardiac Surgery, Vol. 23, No. 3, 05.2008, p. 216-220.

Research output: Contribution to journalArticle

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