Is clamp and sew still viable for thoracic aortic resection?

Michael C. Mauney, Curtis G. Tribble, Jeffrey T. Cope, Reid W. Tribble, A. Luctong, William D. Spotnitz, Irving L. Kron

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objective: The authors reviewed the morbidity and mortality of surgical resection of the descending thoracic and thoracoabdominal aorta using the clamp-and-sew technique. Background: Paraplegia remains a devastating complication after thoraoabdominal aortic resection, despite many strategies for spinal cord protection. Because of its simplicity, clamp and sew has been the preferred technique at the University of Virginia for thoracoabdominal aortic resection when proximal control is possible. Methods: Between 1987 and 1994, the authors reviewed 91 consecutive patients who underwent thoracic aortic resection using clamp-and-sew techniques without any additional adjuncts for spinal cord protection. Results: The average age of patients was 60.8 years; 57.1% were male. No intraoperative deaths occurred. In-hospital mortality was 13% (12/91), with an overall incidence of postoperative spinal cord injury manifested as paraparesis or paraplegia of 9.9% (9/91). Eighty- nine percent (81/91) of all repairs were completed with aortic clamp times of 40 minutes or less, and nearly six out of ten were completed in 30 minutes or less (53/91). Cross-clamp times were not significantly different between those patients who sustained neurologic injury and those who had no deficits. Conclusions: The authors conclude that clamp and sew is still a viable technique for thoracoabdominal aortic resection. Nearly all resections can be completed within 40 minutes of aortic occlusion. However, the 'safe' duration of thoracic aortic occlusion remains unknown, and spinal cord injury can occur even with short clamp times. Reproducible, safe, and technically simple means of spinal cord protection must be developed.

Original languageEnglish (US)
Pages (from-to)534-543
Number of pages10
JournalAnnals of surgery
Volume223
Issue number5
DOIs
StatePublished - May 21 1996
Externally publishedYes

Fingerprint

Spinal Cord
Thorax
Paraplegia
Thoracic Aorta
Spinal Cord Injuries
Paraparesis
Nervous System Trauma
Hospital Mortality
Morbidity
Mortality
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Mauney, M. C., Tribble, C. G., Cope, J. T., Tribble, R. W., Luctong, A., Spotnitz, W. D., & Kron, I. L. (1996). Is clamp and sew still viable for thoracic aortic resection? Annals of surgery, 223(5), 534-543. https://doi.org/10.1097/00000658-199605000-00009

Is clamp and sew still viable for thoracic aortic resection? / Mauney, Michael C.; Tribble, Curtis G.; Cope, Jeffrey T.; Tribble, Reid W.; Luctong, A.; Spotnitz, William D.; Kron, Irving L.

In: Annals of surgery, Vol. 223, No. 5, 21.05.1996, p. 534-543.

Research output: Contribution to journalArticle

Mauney, MC, Tribble, CG, Cope, JT, Tribble, RW, Luctong, A, Spotnitz, WD & Kron, IL 1996, 'Is clamp and sew still viable for thoracic aortic resection?', Annals of surgery, vol. 223, no. 5, pp. 534-543. https://doi.org/10.1097/00000658-199605000-00009
Mauney MC, Tribble CG, Cope JT, Tribble RW, Luctong A, Spotnitz WD et al. Is clamp and sew still viable for thoracic aortic resection? Annals of surgery. 1996 May 21;223(5):534-543. https://doi.org/10.1097/00000658-199605000-00009
Mauney, Michael C. ; Tribble, Curtis G. ; Cope, Jeffrey T. ; Tribble, Reid W. ; Luctong, A. ; Spotnitz, William D. ; Kron, Irving L. / Is clamp and sew still viable for thoracic aortic resection?. In: Annals of surgery. 1996 ; Vol. 223, No. 5. pp. 534-543.
@article{b4f549290c4b4d1a81b92ad8cc67ec6e,
title = "Is clamp and sew still viable for thoracic aortic resection?",
abstract = "Objective: The authors reviewed the morbidity and mortality of surgical resection of the descending thoracic and thoracoabdominal aorta using the clamp-and-sew technique. Background: Paraplegia remains a devastating complication after thoraoabdominal aortic resection, despite many strategies for spinal cord protection. Because of its simplicity, clamp and sew has been the preferred technique at the University of Virginia for thoracoabdominal aortic resection when proximal control is possible. Methods: Between 1987 and 1994, the authors reviewed 91 consecutive patients who underwent thoracic aortic resection using clamp-and-sew techniques without any additional adjuncts for spinal cord protection. Results: The average age of patients was 60.8 years; 57.1{\%} were male. No intraoperative deaths occurred. In-hospital mortality was 13{\%} (12/91), with an overall incidence of postoperative spinal cord injury manifested as paraparesis or paraplegia of 9.9{\%} (9/91). Eighty- nine percent (81/91) of all repairs were completed with aortic clamp times of 40 minutes or less, and nearly six out of ten were completed in 30 minutes or less (53/91). Cross-clamp times were not significantly different between those patients who sustained neurologic injury and those who had no deficits. Conclusions: The authors conclude that clamp and sew is still a viable technique for thoracoabdominal aortic resection. Nearly all resections can be completed within 40 minutes of aortic occlusion. However, the 'safe' duration of thoracic aortic occlusion remains unknown, and spinal cord injury can occur even with short clamp times. Reproducible, safe, and technically simple means of spinal cord protection must be developed.",
author = "Mauney, {Michael C.} and Tribble, {Curtis G.} and Cope, {Jeffrey T.} and Tribble, {Reid W.} and A. Luctong and Spotnitz, {William D.} and Kron, {Irving L.}",
year = "1996",
month = "5",
day = "21",
doi = "10.1097/00000658-199605000-00009",
language = "English (US)",
volume = "223",
pages = "534--543",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Is clamp and sew still viable for thoracic aortic resection?

AU - Mauney, Michael C.

AU - Tribble, Curtis G.

AU - Cope, Jeffrey T.

AU - Tribble, Reid W.

AU - Luctong, A.

AU - Spotnitz, William D.

AU - Kron, Irving L.

PY - 1996/5/21

Y1 - 1996/5/21

N2 - Objective: The authors reviewed the morbidity and mortality of surgical resection of the descending thoracic and thoracoabdominal aorta using the clamp-and-sew technique. Background: Paraplegia remains a devastating complication after thoraoabdominal aortic resection, despite many strategies for spinal cord protection. Because of its simplicity, clamp and sew has been the preferred technique at the University of Virginia for thoracoabdominal aortic resection when proximal control is possible. Methods: Between 1987 and 1994, the authors reviewed 91 consecutive patients who underwent thoracic aortic resection using clamp-and-sew techniques without any additional adjuncts for spinal cord protection. Results: The average age of patients was 60.8 years; 57.1% were male. No intraoperative deaths occurred. In-hospital mortality was 13% (12/91), with an overall incidence of postoperative spinal cord injury manifested as paraparesis or paraplegia of 9.9% (9/91). Eighty- nine percent (81/91) of all repairs were completed with aortic clamp times of 40 minutes or less, and nearly six out of ten were completed in 30 minutes or less (53/91). Cross-clamp times were not significantly different between those patients who sustained neurologic injury and those who had no deficits. Conclusions: The authors conclude that clamp and sew is still a viable technique for thoracoabdominal aortic resection. Nearly all resections can be completed within 40 minutes of aortic occlusion. However, the 'safe' duration of thoracic aortic occlusion remains unknown, and spinal cord injury can occur even with short clamp times. Reproducible, safe, and technically simple means of spinal cord protection must be developed.

AB - Objective: The authors reviewed the morbidity and mortality of surgical resection of the descending thoracic and thoracoabdominal aorta using the clamp-and-sew technique. Background: Paraplegia remains a devastating complication after thoraoabdominal aortic resection, despite many strategies for spinal cord protection. Because of its simplicity, clamp and sew has been the preferred technique at the University of Virginia for thoracoabdominal aortic resection when proximal control is possible. Methods: Between 1987 and 1994, the authors reviewed 91 consecutive patients who underwent thoracic aortic resection using clamp-and-sew techniques without any additional adjuncts for spinal cord protection. Results: The average age of patients was 60.8 years; 57.1% were male. No intraoperative deaths occurred. In-hospital mortality was 13% (12/91), with an overall incidence of postoperative spinal cord injury manifested as paraparesis or paraplegia of 9.9% (9/91). Eighty- nine percent (81/91) of all repairs were completed with aortic clamp times of 40 minutes or less, and nearly six out of ten were completed in 30 minutes or less (53/91). Cross-clamp times were not significantly different between those patients who sustained neurologic injury and those who had no deficits. Conclusions: The authors conclude that clamp and sew is still a viable technique for thoracoabdominal aortic resection. Nearly all resections can be completed within 40 minutes of aortic occlusion. However, the 'safe' duration of thoracic aortic occlusion remains unknown, and spinal cord injury can occur even with short clamp times. Reproducible, safe, and technically simple means of spinal cord protection must be developed.

UR - http://www.scopus.com/inward/record.url?scp=0029985204&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029985204&partnerID=8YFLogxK

U2 - 10.1097/00000658-199605000-00009

DO - 10.1097/00000658-199605000-00009

M3 - Article

C2 - 8651744

AN - SCOPUS:0029985204

VL - 223

SP - 534

EP - 543

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 5

ER -