Surgical results of thoracic aortic aneurysm in the elderly

: Thirty-four patients with arteriosclerotic aortic aneurysm including 25 of the descending aorta and 9 of the thoracoabdominal aneurysm were divided into two groups. Group 1 consisting of 12 patients over 70 years of age, and Group 2 consisting of 22 patients under 69 years of age were compared. Preoperative complications were not significantly different between the two groups. The diameter of the aneurysm was 7.3 +/- 0.7 cm in Group 1 and 6.7 +/- 1.6 cm in Group 2. Calcification of the aorta on CT was prominent in Group 1 (82%) with presumal marked intimal change. Aortic cross clamp time was 72.5 +/- 27.3 min in Group 1 and 60.3 +/- 25.2 min in Group 2. However, in Group 1, 50% required proximal clamping between the left common carotid artery and left subclavian artery. Overall operative mortality for Group 1 was 41% versus 13% in Group 2. The causes of death in Group 1 were intraoperative dissection of the aorta, intraoperative myocardial infarction, intraoperative cerebral infarction, acute embolism of the superior mesentric artery, and pneumonia. In Group 2, excluding two cases of rupture, only one patient died of acute renal failure. In conclusion, patients over 70 years of age died of embolism related to aortic clamping. Thus surgical results may be improved by devising an aortic cross clamp method.