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Heart, Lung and Circulation

Spinal Cord Protection of Aorto-Iliac Bypass in Open Repair of Extent II and III Thoracoabdominal Aortic Aneurysm

  • Xiu-Hua Dong
    Affiliations
    Department of Anaesthesiology, Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, Blood Vessel Diseases, Beijing, China
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  • Yi-Peng Ge
    Affiliations
    Department of Cardiovascular Surgery, Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, Blood Vessel Diseases, Beijing Aortic Disease Center, Beijing, China
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  • Rong Wang
    Affiliations
    Department of Anaesthesiology, Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, Blood Vessel Diseases, Beijing, China
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  • Xu-Dong Pan
    Affiliations
    Department of Cardiovascular Surgery, Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, Blood Vessel Diseases, Beijing Aortic Disease Center, Beijing, China
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  • Jia-Kai Lu
    Affiliations
    Department of Anaesthesiology, Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, Blood Vessel Diseases, Beijing, China
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  • Wei-Ping Cheng
    Correspondence
    Corresponding author at: Department of Anaesthesiology, Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
    Affiliations
    Department of Anaesthesiology, Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, Blood Vessel Diseases, Beijing, China
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      Background

      Spinal cord injury (SCI) is one of the serious complications of thoracoabdominal aortic aneurysm (TAAA) repair. Cardiopulmonary bypass (CPB) and left heart bypass (LHB) are well-established extracorporeal circulatory assistance methods to increase distal aortic perfusion and prevent spinal cord ischaemia in TAAA repair. Aorto-iliac bypass, a new surgical adjunct offering distal aortic perfusion without the need of complex perfusion skills, was developed as a substitute for CPB and LHB. However, its spinal cord protective effect is unknown.

      Methods

      The perioperative data of 183 patients who had elective open Crawford extent II and III TAAA repair at our aortic centre from July 2011 to May 2019 were retrospectively analysed. Spinal cord protection was compared between the aorto-iliac bypass group (n=106) and the extracorporeal circulatory assistance group (n=77 [65 CPB, 12 LHB]), and the risk factors for SCI in these patients were explored.

      Results

      Eleven (11) patients had postoperative SCI: five (6.5%) in the extracorporeal circulatory assistance group (four with CPB and one with LHB), and six (5.7%) in the aorto-iliac bypass group. The incidence of SCI was 6.0% (11/183 cases). There was no difference between the aorto-iliac bypass group and the extracorporeal circulatory assistance group (p=1.0), while operation time, proximal aortic clamp time, intercostal artery clamp time, and length of intensive care unit stay were all increased in the latter group. Multivariate logistic regression analysis showed that cerebrospinal fluid pressure (odds ratio [OR] 1.270; 95% confidence interval [CI] 1.092–1.478 [p=0.002]) and lowest haemoglobin on the first postoperative day (OR 0.610; 95% CI 0.416–0.895 [p=0.011]) were the independent predictors of SCI in TAAA repair.

      Conclusions

      Spinal cord protection of aorto-iliac bypass is comparable to that of CPB and LHB in open TAAA repair.

      Keywords

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      References

        • Coselli J.S.
        • LeMaire S.A.
        • Preventza O.
        • de la Cruz K.I.
        • Cooley D.A.
        • Price M.D.
        • et al.
        Outcomes of 3309 thoracoabdominal aortic aneurysm repairs.
        J Thorac Cardiovasc Surg. 2016; 151: 1323-1337
        • Coselli J.S.
        • Green S.Y.
        • Price M.D.
        • Zhang Q.
        • Preventza O.
        • de la Cruz K.I.
        • et al.
        Spinal cord deficit after 1114 extent II open thoracoabdominal aortic aneurysm repairs.
        J Thorac Cardiovasc Surg. 2019; (Epub ahead of print)https://doi.org/10.1016/j.jtcvs.2019.01.120
        • Moulakakis K.G.
        • Karaolanis G.
        • Antonopoulos C.N.
        • Kakisis J.
        • Klonaris C.
        • Preventza O.
        • et al.
        Open repair of thoracoabdominal aortic aneurysms in experienced centers.
        J Vasc Surg. 2018; 68: 634-645
        • Estrera A.L.
        • Sandhu H.K.
        • Charlton-Ouw K.M.
        • Afifi R.O.
        • Azizzadeh A.
        • Miller 3rd, C.C.
        • et al.
        A quarter century of organ protection in open thoracoabdominal repair.
        Ann Surg. 2015; 262: 660-668
        • Etz C.D.
        • Weigang E.
        • Hartert M.
        • Lonn L.
        • Mestres C.A.
        • Di Bartolomeo R.
        • et al.
        Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery.
        Eur J Cardiothorac Surg. 2015; 47: 943-957
        • Estrera A.L.
        • Miller C.C.
        • Azizzadeh A.
        • Safi H.J.
        Adjuncts during surgery of the thoracoabdominal aorta and their impact on neurologic outcome: distal aortic perfusion and cerebrospinal fluid drainage.
        Multimed Man Cardiothorac Surg. 2006; 2006 (mmcts.2006.001933)
        • Kulik A.
        • Castner C.F.
        • Kouchoukos N.T.
        Outcomes after thoracoabdominal aortic aneurysm repair with hypothermic circulatory arrest.
        J Thorac Cardiovasc Surg. 2011; 141: 953-960
        • Wahlgren C.M.
        • Blohmé L.
        • Günther A.
        • Nilsson L.
        • Olsson C.
        Outcomes of left heart bypass versus circulatory arrest in elective open surgical descending and thoraco-abdominal aortic repair.
        Eur J Vasc Endovasc Surg. 2017; 53: 672-678
        • Duan Y.Y.
        • Ge Y.P.
        • Zheng J.
        • Pan X.D.
        • Dong X.H.
        • Ma W.G.
        • et al.
        Aorta-iliac bypass in thoracoabdominal aortic aneurysm repair in young Chinese patients.
        Heart Lung Circ. 2016; 25: 398-404
        • Monnot A.
        • Rouer M.
        • Horion J.
        • Plissonnier D.
        Axillofemoral bypass for kidney transplant protection during open repair of abdominal aortic aneurysm.
        Ann Vasc Surg. 2015; 29: 1315
        • Cooley D.A.
        • Golino A.
        • Frazier O.H.
        Single-clamp technique for aneurysms of the descending thoracic aorta: report of 132 consecutive cases.
        Eur J Cardiothorac Surg. 2000; 18: 162-167
        • Epstein N.E.
        Cerebrospinal fluid drains reduce risk of spinal cord injury for thoracic/thoracoabdominal aneurysm surgery: a review.
        Surg Neurol Int. 2018; 9: 48
        • Coselli J.S.
        • LeMaire S.A.
        • Köksoy C.
        • Schmittling Z.C.
        • Curling P.E.
        Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial.
        J Vasc Surg. 2002; 35: 631-639
        • Azizzadeh A.
        • Huynh T.T.
        • Miller 3rd, C.C.
        • Estrera A.L.
        • Porat E.E.
        • Sheinbaum R.
        • et al.
        Postoperative risk factors for delayed neurologic deficit after thoracic and thoracoabdominal aortic aneurysm repair: a case-control study.
        J Vasc Surg. 2003; 37: 750-754
        • Hnath J.C.
        • Mehta M.
        • Taggert J.B.
        • Sternbach Y.
        • Roddy S.P.
        • Kreienberg P.B.
        • et al.
        Strategies to improve spinal cord ischemia in endovascular thoracic aortic repair: outcomes of a prospective cerebrospinal fluid drainage protocol.
        J Vasc Surg. 2008; 48: 836-840
        • Youngblood S.C.
        • Tolpin D.A.
        • LeMaire S.A.
        • Coselli J.S.
        • Lee V.V.
        • Cooper Jr., J.R.
        Complications of cerebrospinal fluid drainage after thoracic aortic surgery: a review of 504 patients over 5 years.
        J Thorac Cardiovasc Surg. 2013; 146: 166-171
        • Wynn M.M.
        • Sebranek J.
        • Marks E.
        • Engelbert T.
        • Acher C.W.
        Complications of spinal fluid drainage in thoracic and thoracoabdominal aortic aneurysm surgery in 724 patients treated from 1987 to 2013.
        J Cardiothorac Vasc Anaesth. 2015; 29: 342-350
        • Bisdas T.
        • Panuccio G.
        • Sugimoto M.
        • Torsello G.
        • Austermann M.
        Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms.
        J Vasc Surg. 2015; 61: 1408-1416
        • Hogervorst E.K.
        • Rosseel P.M.
        • van de Watering L.M.
        • Brand A.
        • Bentala M.
        • van der Bom J.G.
        • et al.
        Intraoperative anemia and single red blood cell transfusion during cardiac surgery: an assessment of postoperative outcome including patients refusing blood transfusion.
        J Cardiothorac Vasc Anaesth. 2016; 30: 363-372
        • Zangrillo A.
        • Buratti L.
        • Carozzo A.
        • Casiraghi G.
        • Landoni G.
        • Lembo R.
        • et al.
        Intrathecal lactate as a predictor of early- but not late-onset spinal cord injury in thoracoabdominal aneurysmectomy.
        J Cardiothorac Vasc Anaesth. 2014; 28: 473-478
        • Zoli S.
        • Roder F.
        • Etz C.D.
        • Brenner R.M.
        • Bodian C.A.
        • Lin H.M.
        • et al.
        Predicting the risk of paraplegia after thoracic and thoracoabdominal aneurysm repair.
        Ann Thorac Surg. 2010; 90: 1237-1244
        • Zhang L.
        • Sun X.G.
        • Yu C.T.
        • Chang Q.
        • Qian X.Y.
        Intercostal artery reconstruction: the simple and effective technique on spinal cord protection during thoracoabdominal aortic replacement.
        Ann Vasc Surg. 2016; 34: 62-67
        • Rossi S.H.
        • Patel A.
        • Saha P.
        • Gwozdz A.
        • Salter R.
        • Gkoutzios P.
        • et al.
        Neuroprotective strategies can prevent permanent paraplegia in the majority of patients who develop spinal cord ischaemia after endovascular repair of thoracoabdominal aortic aneurysms.
        Eur J Vasc Endovasc Surg. 2015; 50: 599-607