Research progress on perioperative management of thoraco-abdominal aortic aneurysm surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIE Yan ¹ ,  SONG Yi ¹ ,  GUAN Yulong ²

1. Department of Extracorporeal Circulation, Fuwai Yunnan Cardiovascular Hospital, Kunming, 650102, P. R. China;
2. Department of Extracorporeal Circulation, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

SONG Yi, Email: Drsongyi@163.com; GUAN Yulong, Email: guanyulong2014@163.com

Keywords：

Thoraco-abdominal aortic aneurysm; surgery; extracorporeal circulation; spinal cord dysfunction; review

DOI：

10.7507/1007-4848.202302045

Video：

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The surgical treatment of thoraco-abdominal aortic aneurysm (TAAA) requires a unique multidisciplinary approach. A thorough preoperative examination and evaluation are essential to determine the optimal timing for surgery and to optimize organ function as needed. During the perioperative period, excellent surgical skills and an appropriate strategy for extracorporeal circulation will be employed based on the extent of the aneurysm. Additionally, necessary measures will be taken to monitor and protect the functions of vital organs. Close monitoring and management in the postoperative stage, along with early detection of complications and effective treatment, are crucial for improving the prognosis of TAAA surgery. This article reviews the current research progress in the perioperative management of TAAA surgery.

Citation： XIE Yan, SONG Yi, GUAN Yulong. Research progress on perioperative management of thoraco-abdominal aortic aneurysm surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(2): 258-262. doi: 10.7507/1007-4848.202302045 Copy

1.	Kalder J, Kotelis D, Jacobs MJ. Thoracoabdominal aortic aneurysm. Chirurg, 2016, 87(9): 797-810.
2.	Zafar MA, Chen JF, Wu J, et al. Natural history of descending thoracic and thoracoabdominal aortic aneurysms. J Thorac Cardiovasc Surg, 2021, 161(2): 498-511.
3.	Chatterjee S, Casar JG, LeMaire SA, et al. Perioperative care after thoracoabdominal aortic aneurysm repair: The Baylor College of Medicine experience. Part 1: Preoperative considerations. J Thorac Cardiovasc Surg, 2021, 161(2): 693-698.
4.	Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol, 2014, 64(22): e77-e137.
5.	Girardi LN, Lau C, Munjal M, et al. Impact of preoperative pulmonary function on outcomes after open repair of descending and thoracoabdominal aortic aneurysms. J Thorac Cardiovasc Surg, 2017, 153(2): S22-S29.
6.	Coselli JS, Amarasekara HS, Zhang Q, et al. The impact of preoperative chronic kidney disease on outcomes after Crawford extent Ⅱ thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg, 2018, 156(6): 2053-2064.
7.	Tan CW, Wall M, Rosengart TK, et al. How to bridge? Management of anticoagulation in patients with mechanical heart valves undergoing noncardiac surgical procedures. J Thorac Cardiovasc Surg, 2019, 158(1): 200-203.
8.	Kärkkäinen JM, Pather K, Tenorio ER, et al. Should endovascular approach be considered as the first option for thoraco-abdominal aortic aneurysms? J Cardiovasc Surg (Torino), 2019, 60(3): 298-312.
9.	Tanaka A, Oderich GS, Estrera AL. Total abdominal debranching hybrid thoracoabdominal aortic aneurysm repair versus chimneys and snorkels. JTCVS Tech, 2021, 10: 28-33.
10.	Kouchoukos NT, Kulik A, Haynes M, et al. Early outcomes after thoracoabdominal aortic aneurysm repair with hypothermic circulatory arrest. Ann Thorac Surg, 2019, 108(5): 1338-1343.
11.	Norton EL, Orelaru F, Ahmad RA, et al. Hypothermic circulatory arrest versus aortic clamping in thoracic and thoracoabdominal aortic aneurysm repair. J Card Surg, 2022, 37(12): 4351-4358.
12.	Green SY, Safi HJ, Coselli JS. A history of open thoracoabdominal aortic aneurysm repair: Perspective from Houston. J Cardiovasc Surg (Torino), 2021, 62(3): 191-202.
13.	Tanaka A, Estrera AL, Safi HJ. Open thoracoabdominal aortic aneurysm surgery technique: How we do it. J Cardiovasc Surg (Torino), 2021, 62(4): 295-301.
14.	Lopez-Marco A, Adams B, Oo AY. Thoracoabdominal aneurysmectomy: Operative steps for Crawford extent Ⅱ repair. JTCVS Tech, 2020, 3: 25-36.
15.	马明星, 常谦, 于存涛, 等. 外科治疗DeBakeyⅠ型和Ⅲ型夹层合并胸腹主动脉瘤的结果对比. 中国医学科学院学报, 2020, 42(3): 319-326.Ma MX, Chang Q, Yu CT, et al. Outcomes after surgical repair of thoracoabdominal aortic aneurysm with distal aortic dissection: DeBakey type Ⅰ versus type Ⅲ. Acta Acdem Med Sin, 2020, 42(3): 319-326.
16.	李军, 石佳, 陈雷, 等. 非体外循环全胸腹主动脉置换术的麻醉处理. 中华医学杂志, 2013, 93(7): 528-530.Li J, Shi J, Chen L, et al. Anesthetic management for patients undergoing total thoracoabdominal aorta replacement without cardiopulmonary bypass. Natl Med J China, 2013, 93(7): 528-530.
17.	Chatterjee S, Casar JG, LeMaire SA, et al. Perioperative care after thoracoabdominal aortic aneurysm repair: The Baylor College of Medicine experience. Part 2: Postoperative management. J Thorac Cardiovasc Surg, 2021, 161(2): 699-705.
18.	Imamura Y, Kin H, Yoshioka K, et al. Thoracoabdominal aortic aneurysm repair based on pre- and postoperative evaluation of the artery of Adamkiewicz. Eur J Cardiothorac Surg, 2022, 62(5): ezac196.
19.	Haunschild J, von Aspern K, Herajärvi J, et al. Impact of distal aortic perfusion on 'segmental steal' depleting spinal cord blood flow—A quantitative experimental approach. Eur J Cardiothorac Surg, 2022, 62(5): ezac213.
20.	Hage A, Bozinovski J, Ouzounian M, et al. Commentary: Expertise in thoracoabdominal aortic aneurysm repair-More than just the knife. J Thorac Cardiovasc Surg, 2021, 161(2): 706-707.

1. Kalder J, Kotelis D, Jacobs MJ. Thoracoabdominal aortic aneurysm. Chirurg, 2016, 87(9): 797-810.
2. Zafar MA, Chen JF, Wu J, et al. Natural history of descending thoracic and thoracoabdominal aortic aneurysms. J Thorac Cardiovasc Surg, 2021, 161(2): 498-511.
3. Chatterjee S, Casar JG, LeMaire SA, et al. Perioperative care after thoracoabdominal aortic aneurysm repair: The Baylor College of Medicine experience. Part 1: Preoperative considerations. J Thorac Cardiovasc Surg, 2021, 161(2): 693-698.
4. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol, 2014, 64(22): e77-e137.
5. Girardi LN, Lau C, Munjal M, et al. Impact of preoperative pulmonary function on outcomes after open repair of descending and thoracoabdominal aortic aneurysms. J Thorac Cardiovasc Surg, 2017, 153(2): S22-S29.
6. Coselli JS, Amarasekara HS, Zhang Q, et al. The impact of preoperative chronic kidney disease on outcomes after Crawford extent Ⅱ thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg, 2018, 156(6): 2053-2064.
7. Tan CW, Wall M, Rosengart TK, et al. How to bridge? Management of anticoagulation in patients with mechanical heart valves undergoing noncardiac surgical procedures. J Thorac Cardiovasc Surg, 2019, 158(1): 200-203.
8. Kärkkäinen JM, Pather K, Tenorio ER, et al. Should endovascular approach be considered as the first option for thoraco-abdominal aortic aneurysms? J Cardiovasc Surg (Torino), 2019, 60(3): 298-312.
9. Tanaka A, Oderich GS, Estrera AL. Total abdominal debranching hybrid thoracoabdominal aortic aneurysm repair versus chimneys and snorkels. JTCVS Tech, 2021, 10: 28-33.
10. Kouchoukos NT, Kulik A, Haynes M, et al. Early outcomes after thoracoabdominal aortic aneurysm repair with hypothermic circulatory arrest. Ann Thorac Surg, 2019, 108(5): 1338-1343.
11. Norton EL, Orelaru F, Ahmad RA, et al. Hypothermic circulatory arrest versus aortic clamping in thoracic and thoracoabdominal aortic aneurysm repair. J Card Surg, 2022, 37(12): 4351-4358.
12. Green SY, Safi HJ, Coselli JS. A history of open thoracoabdominal aortic aneurysm repair: Perspective from Houston. J Cardiovasc Surg (Torino), 2021, 62(3): 191-202.
13. Tanaka A, Estrera AL, Safi HJ. Open thoracoabdominal aortic aneurysm surgery technique: How we do it. J Cardiovasc Surg (Torino), 2021, 62(4): 295-301.
14. Lopez-Marco A, Adams B, Oo AY. Thoracoabdominal aneurysmectomy: Operative steps for Crawford extent Ⅱ repair. JTCVS Tech, 2020, 3: 25-36.
15. 马明星, 常谦, 于存涛, 等. 外科治疗DeBakeyⅠ型和Ⅲ型夹层合并胸腹主动脉瘤的结果对比. 中国医学科学院学报, 2020, 42(3): 319-326.Ma MX, Chang Q, Yu CT, et al. Outcomes after surgical repair of thoracoabdominal aortic aneurysm with distal aortic dissection: DeBakey type Ⅰ versus type Ⅲ. Acta Acdem Med Sin, 2020, 42(3): 319-326.
16. 李军, 石佳, 陈雷, 等. 非体外循环全胸腹主动脉置换术的麻醉处理. 中华医学杂志, 2013, 93(7): 528-530.Li J, Shi J, Chen L, et al. Anesthetic management for patients undergoing total thoracoabdominal aorta replacement without cardiopulmonary bypass. Natl Med J China, 2013, 93(7): 528-530.
17. Chatterjee S, Casar JG, LeMaire SA, et al. Perioperative care after thoracoabdominal aortic aneurysm repair: The Baylor College of Medicine experience. Part 2: Postoperative management. J Thorac Cardiovasc Surg, 2021, 161(2): 699-705.
18. Imamura Y, Kin H, Yoshioka K, et al. Thoracoabdominal aortic aneurysm repair based on pre- and postoperative evaluation of the artery of Adamkiewicz. Eur J Cardiothorac Surg, 2022, 62(5): ezac196.
19. Haunschild J, von Aspern K, Herajärvi J, et al. Impact of distal aortic perfusion on 'segmental steal' depleting spinal cord blood flow—A quantitative experimental approach. Eur J Cardiothorac Surg, 2022, 62(5): ezac213.
20. Hage A, Bozinovski J, Ouzounian M, et al. Commentary: Expertise in thoracoabdominal aortic aneurysm repair-More than just the knife. J Thorac Cardiovasc Surg, 2021, 161(2): 706-707.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Research progress on perioperative management of thoraco-abdominal aortic aneurysm surgery

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