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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Outcomes of 3309 thoracoabdominal aortic aneurysm repairs.J Thorac Cardiovasc Surg. 2016; 151: 1323-1337
- 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
- Open repair of thoracoabdominal aortic aneurysms in experienced centers.J Vasc Surg. 2018; 68: 634-645
- A quarter century of organ protection in open thoracoabdominal repair.Ann Surg. 2015; 262: 660-668
- 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
- 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)
- Outcomes after thoracoabdominal aortic aneurysm repair with hypothermic circulatory arrest.J Thorac Cardiovasc Surg. 2011; 141: 953-960
- 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
- Aorta-iliac bypass in thoracoabdominal aortic aneurysm repair in young Chinese patients.Heart Lung Circ. 2016; 25: 398-404
- Axillofemoral bypass for kidney transplant protection during open repair of abdominal aortic aneurysm.Ann Vasc Surg. 2015; 29: 1315
- Single-clamp technique for aneurysms of the descending thoracic aorta: report of 132 consecutive cases.Eur J Cardiothorac Surg. 2000; 18: 162-167
- Cerebrospinal fluid drains reduce risk of spinal cord injury for thoracic/thoracoabdominal aneurysm surgery: a review.Surg Neurol Int. 2018; 9: 48
- Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial.J Vasc Surg. 2002; 35: 631-639
- 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
- 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
- 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
- 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
- Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms.J Vasc Surg. 2015; 61: 1408-1416
- 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
- 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
- Predicting the risk of paraplegia after thoracic and thoracoabdominal aneurysm repair.Ann Thorac Surg. 2010; 90: 1237-1244
- Intercostal artery reconstruction: the simple and effective technique on spinal cord protection during thoracoabdominal aortic replacement.Ann Vasc Surg. 2016; 34: 62-67
- 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
Article info
Publication history
Published online: July 06, 2021
Accepted:
May 26,
2021
Received in revised form:
December 5,
2020
Received:
October 18,
2019
Identification
Copyright
© 2021 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
