Understanding Open Repair of the Descending Thoracic and Thoracoabdominal Aorta

  • Jay K. Bhama
  • Scott A. LeMaire
  • John R. Cooper
  • Joseph S. Coselli


Although substantial innovation has characterized the field of aortic surgery during the last 50 years, successful repair remains a formidable challenge. Aortic repair has grown to encompass adjuncts designed to ameliorate specific surgical morbidities, such as spinal cord and renal ischemia, while the strategy of repair remains largely dictated by the extent of repair. Repair of the distal aorta, namely the descending thoracic and thoracoabdominal aorta, poses different risks than proximal aortic repair; thus, operative strategy and expected outcomes vary tremendously with the extent of aorta that requires replacement. An accurate understanding of the extent of aortic involvement is critical to planning appropriate management.


Thoracic Aorta Left Subclavian Artery False Lumen Spinal Cord Ischemia Thoracic Aortic Aneurysm 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors express gratitude to Stephen N. Palmer, PhD, ELS, and Angela T. Odensky, MA, of the Texas Heart Institute, as well as Susan Y. Green, MPH, for editorial assistance, and Scott A. Weldon, MA, CMI, and Carol P. Larson, CMI, for creating the illustrations and assisting with image selection.


  1. 1.
    Coselli JS. The use of left heart bypass in the repair of thoracoabdominal aortic aneurysms: current techniques and results. Semin Thorac Cardiovasc Surg. 2003;15:326–332.CrossRefPubMedGoogle Scholar
  2. 2.
    Coselli JS, Bozinovski J, Cheung C. Hypothermic ­circulatory arrest: safety and efficacy in the operative treatment of descending and thoracoabdominal aortic aneurysms. Ann Thorac Surg. 2008;85:956–963. discussion 964.CrossRefPubMedGoogle Scholar
  3. 3.
    Huh J, LeMaire SA, Bozinovski J, Coselli JS. Perfusion for thoracic aortic surgery. In: Gravlee GP, Davis RE, Stammers AH, Ungerleider RM, eds. Cardiopulmonary Bypass: Principles and Practice. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2008:647–661.Google Scholar
  4. 4.
    Cambria R. Commentary: Thoracic and thoracoabdominal aneurysm repair: is reimplantation of spinal cord arteries a waste of time? Perspect Vasc Surg Endovasc Ther. 2008;20:221–223.CrossRefGoogle Scholar
  5. 5.
    Coselli JS, LeMaire SA, Köksoy C, Schmittling ZC, Curling PE. Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial. J Vasc Surg. 2002;35:631–639.CrossRefPubMedGoogle Scholar
  6. 6.
    Coselli JS, LeMaire SA, Schmittling ZC, Köksoy C. Cerebrospinal fluid drainage in thoracoabdominal aortic surgery. Semin Vasc Surg. 2000;13:308–314.PubMedGoogle Scholar
  7. 7.
    Black JH, Davison JK, Cambria RP. Regional hypothermia with epidural cooling for prevention of spinal cord ischemic complications after thoracoabdominal aortic surgery. Semin Thorac Cardiovasc Surg. 2003;15:345–352.CrossRefPubMedGoogle Scholar
  8. 8.
    Köksoy C, LeMaire SA, Curling PE, et al. Renal perfusion during thoracoabdominal aortic operations: cold crystalloid is superior to normothermic blood. Ann Thorac Surg. 2002;73:730–738.CrossRefPubMedGoogle Scholar
  9. 9.
    LeMaire SA, Jones MM, Conklin LD, et al. Randomized comparison of cold blood and cold crystalloid renal perfusion for renal protection during ­thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2009;49:11–19. discussion 19.CrossRefPubMedGoogle Scholar
  10. 10.
    Rokkas CK, Kouchoukos NT. Hypothermic circulatory arrest in the treatment of descending thoracic and thoracoabdominal aortic disease. Ann Thorac Surg. 2008;86:1399–1400.CrossRefPubMedGoogle Scholar
  11. 11.
    Dias RR, Coselli JS, Stolf NAG, Dias AR, Mady C, Oliveira SA. Aneurysmal dilation of the reimplant segment of the visceral vessels after ­thoracoabdominal aneurysm correction. Arq Bras Cardiol. 2003;81:273–278.CrossRefPubMedGoogle Scholar
  12. 12.
    Coselli JS, Bozinovski J, LeMaire SA. Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg. 2007;83:S862–864.CrossRefPubMedGoogle Scholar
  13. 13.
    MacArthur RG, Carter SA, Coselli JS, LeMaire SA. Organ protection during thoracoabdominal aortic surgery: rationale for a multimodality approach. Semin Cardiothorac Vasc Anesth. 2005;9:143–149.CrossRefPubMedGoogle Scholar
  14. 14.
    Cohn LH. (ed): Cardiac Surgery in the Adult. 3rd ed. New York: McGraw-Hill; 2008.Google Scholar
  15. 15.
    Gardner TJ, Spray TL, eds. Operative Cardiac Surgery. 5th ed. New York: Arnold Ltd; 2004.Google Scholar
  16. 16.
    Gravlee GP, Davis RF, Stammers AH, Ungerleider RM, eds. Cardiopulmonary Bypass: Principles and Practice. 3rd ed. Philadelphia: Lippincott, Williams, and Wilkins, Wolters Kluwer; 2008.Google Scholar

Further Reading

  1. 17.
    Acher CW, Wynn M. A modern theory of paraplegia in the treatment of aneurysms of the thoracoabdominal aorta: an analysis of technique specific observed/expected ratios for paralysis. J Vasc Surg. 2009;49:1117–1124. discussion 1124.CrossRefPubMedGoogle Scholar
  2. 18.
    Black JH III, Cambria RP. Contemporary results of open surgical repair of descending thoracic aortic aneurysms. Semin Vasc Surg. 2006;19:11–17.CrossRefPubMedGoogle Scholar
  3. 19.
    Conrad MF, Crawford RS, Davison JK, Cambria RP. Thoracoabdominal aneurysm repair: a 20-year perspective. Ann Thorac Surg. 2007;83:S856–861.CrossRefPubMedGoogle Scholar
  4. 20.
    Coselli JS, LeMaire SA. Tips for successful outcomes for descending thoracic and thoracoabdominal aortic aneurysm procedures. Semin Vasc Surg. 2008;21:13–20.CrossRefPubMedGoogle Scholar
  5. 21.
    Coselli JS, LeMaire SA, Bhama JK. Thoracoabdominal aortic aneurysm. In: Gardner TJ, Spray TL, eds. Operative Cardiac Surgery. 5th ed. New York: Oxford University Press; 2004:483–494.Google Scholar
  6. 22.
    Coselli JS, LeMaire SA, Carter SA, Conklin LD. The reversed elephant trunk technique used for treatment of complex aneurysms of the entire thoracic aorta. Ann Thorac Surg. 2005;80:2166–2172. discussion 2172.CrossRefPubMedGoogle Scholar
  7. 23.
    Coselli JS, LeMaire SA, Conklin LD, Adams GJ. Left heart bypass during descending thoracic aortic aneurysm repair does not reduce the incidence of paraplegia. Ann Thorac Surg. 2004;77:1298–1303.CrossRefPubMedGoogle Scholar
  8. 24.
    Coselli JS, LeMaire SA, Conklin LD, Koksoy C, Schmittling ZC. Morbidity and mortality after extent II thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 2002;73:1107–1115. discussion 1115–1106.CrossRefPubMedGoogle Scholar
  9. 25.
    Coselli JS, LeMaire SA, Miller CC III, et al. Mortality and paraplegia after thoracoabdominal aortic aneurysm repair: a risk factor analysis. Ann Thorac Surg. 2000;69:409–414.CrossRefPubMedGoogle Scholar
  10. 26.
    LeMaire SA, Carter SA, Coselli JS. The elephant trunk technique for staged repair of complex aneurysms of the entire thoracic aorta. Ann Thorac Surg. 2006;81:1561–1569. discussion 1569.CrossRefPubMedGoogle Scholar
  11. 27.
    LeMaire SA, Miller CC III, Conklin LD, Schmittling ZC, Coselli JS. Estimating group mortality and paraplegia rates after thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 2003;75:508–513.CrossRefPubMedGoogle Scholar
  12. 28.
    LeMaire SA, Miller CC III, Conklin LD, Schmittling ZC, Köksoy C, Coselli JS. A new predictive model for adverse outcomes after elective thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 2001;71:1233–1238.CrossRefPubMedGoogle Scholar
  13. 29.
    LeMaire SA, Pannu H, Tran-Fadulu V, Carter SA, Coselli JS, Milewicz DM. Severe aortic and arterial aneurysms associated with a TGFBR2 mutation. Nat Clin Pract Cardiovasc Med. 2007;4:167–171.CrossRefPubMedGoogle Scholar
  14. 30.
    Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg. 1993;17:357–368.CrossRefPubMedGoogle Scholar
  15. 31.
    Wong DR, Lemaire SA, Coselli JS. Managing dissections of the thoracic aorta. Am Surg. 2008;74:364–380.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Jay K. Bhama
    • 1
  • Scott A. LeMaire
  • John R. Cooper
  • Joseph S. Coselli
  1. 1.Division of Cardiac Surgery, Department of Cardiothoracic SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA

Personalised recommendations