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Technical and clinical aspects of surgery for thoracic aortic aneurysms (open): basic techniques of surgery for thoracoabdominal aneurysms, techniques for arch reconstruction, protection of spinal cord, prevention of stroke, results of open surgery 

Technical and clinical aspects of surgery for thoracic aortic aneurysms (open): basic techniques of surgery for thoracoabdominal aneurysms, techniques for arch reconstruction, protection of spinal cord, prevention of stroke, results of open surgery
Chapter:
Technical and clinical aspects of surgery for thoracic aortic aneurysms (open): basic techniques of surgery for thoracoabdominal aneurysms, techniques for arch reconstruction, protection of spinal cord, prevention of stroke, results of open surgery
Author(s):

Stephen Large

and Priya Sastry

DOI:
10.1093/med/9780199658220.003.0057
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date: 18 September 2019

Open surgical repair of the aortic arch and descending thoracic aorta remains one of the biggest challenges to cardiovascular surgeons. In specialist centres the mortality risk from surgical repair has fallen to 5–10% from 20% a decade ago. However, the risk of debilitating morbidity remains the greatest concern since surgery for the arch and descending aorta affects the cerebral, spinal, visceral, and peripheral circulations. Therefore although the surgical techniques remain largely unchanged over the past 50 years since Michael DeBakey first repaired an aneurysm, much attention has been paid to the adjuncts that may protect the patient from stroke, paraplegia, or visceral ischaemia. In this chapter, we will cover the surgical techniques, describe the adjuncts available, and summarize the best current evidence and guidelines for arch and descending thoracic aortic surgery.

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