Nicholas T Kouchoukos MD

Cardiothoracic Surgeon Missouri Baptist Hospital St. Louis, Missouri

T^v URING THE LAST DECADE, I I extraordinary progress has _L^been made in the treatment of aneurysms of the thoracic and thoracoabdominal aorta. We have better diagnostic techniques as well as improved substitutions for the aortic wall and safer systems to protect patients during surgery.

Currently, it is possible to safely cool the brain to low temperatures (12° to 15°C, or 54° to 59°F) by using the heart-lung machine. At these temperatures, the circulation can be totally stopped for up to forty-five minutes (and sometimes even longer) without producing detectable injury to the brain. This allows surgeons to remove diseased seg

ments of the ascending aorta and aortic arch with a mortality in most instances of 10 percent or less and a correspondingly low incidence of brain damage.

Until recently, operations to replace long segments of the descending thoracic or thoracoab-dominal aorta were associated with a high risk of death, a high risk of paralysis (up to 40 percent) of the legs (paraplegia), and a risk of kidney failure. Fortunately, however, this risk for this kind of aortic surgery has been lowered. Doctors support the circulation with a pump or a heart-lung machine, and in some instances cool the spinal cord and kidneys during operations. Surgery on these segments of the aorta can now be performed with a mortality of10 percent or less and a risk of paralysis or kidney failure that does not exceed 5 percent.

As techniques in heart surgery improve, it is possible to operate on older victims of heart disease. This raises new questions for both the patient and the family.

CHAPTER FOURTEEN

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