Spinal cord protection during thoracoabdominal aortic replacement: spinal cord perfusion maintenance

Interact Cardiovasc Thorac Surg. 2017 May 1;24(5):708-713. doi: 10.1093/icvts/ivw450.

Abstract

Objectives: Spinal cord protection during thoracoabdominal aortic surgery is challenging for surgeons. We performed thoracoabdominal replacement using a strategy for maintaining spinal cord perfusion pressure. Here, we report our experience with this procedure and the surgical outcomes.

Methods: Between January 2000 and December 2014, 130 patients [male: 91 (74.6%), female: 39 (25.4%); mean age: 66.6 ± 12.8 years] underwent thoracoabdominal replacement using cardiopulmonary bypass at Hiroshima Shimin Hospital, Japan. The surgical outcomes of these patients were analysed.

Results: The in-hospital mortality rate of all patients was 2.5%. The incidence of postoperative paraplegia was 3.8%. Aortic event-free survival rates at 1, 3 and 5 years were 98.2%, 93.9% and 80.7%, respectively.

Conclusions: The present study suggests that our strategy for maintaining spinal cord perfusion pressure provides acceptable outcomes.

Keywords: Intercostal artery reconstruction; Paraplegia; Spinal ischaemia; Thoracoabdominal replacement.

MeSH terms

  • Aged
  • Aortic Aneurysm, Thoracic / diagnosis
  • Aortic Aneurysm, Thoracic / surgery*
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Disease-Free Survival
  • Female
  • Hospital Mortality / trends
  • Humans
  • Incidence
  • Intraoperative Care / methods*
  • Intraoperative Complications / epidemiology
  • Intraoperative Complications / prevention & control*
  • Japan / epidemiology
  • Male
  • Perfusion / methods*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control*
  • Retrospective Studies
  • Spinal Cord / blood supply*
  • Spinal Cord Ischemia / epidemiology
  • Spinal Cord Ischemia / etiology
  • Spinal Cord Ischemia / prevention & control*
  • Survival Rate / trends
  • Tomography, X-Ray Computed
  • Treatment Outcome