Original article: cardiovascularInterventions for reversing delayed-onset postoperative paraplegia after thoracic aortic reconstruction
Section snippets
Material and methods
All patients undergoing TAA or TAAA repair from January 1, 2000 to August 31, 2001 were prospectively entered into a clinical database. Patients in this database with postoperative paraplegia were identified and analyzed. TAAA were classified according to Crawford type I to IV. In addition, aneurysms isolated to the thoracic aorta (TAA) were included. Descending aneurysms with concomitant distal arch extension were also included (Table 1). Patients with Crawford type IV aortic aneurysms
Results
During the study period, 99 patients underwent thoracic or thoracoabdominal aortic replacement. This cohort was 55% male and had a mean age of 68 ± 15 years (Table 1). Included in the cohort were 19 patients with combined thoracic and thoracoabdominal aneurysms with distal arch extension requiring an “open proximal anastomosis” utilizing HCA techniques. Intercostal artery implantation rate was near 100% in patients with dissecting aortic aneurysms, but only 25% in patients with atherosclerotic
Comment
Postoperative paraplegia has been a well-recognized complication of operations to replace the descending thoracic or abdominal aorta and has an estimated incidence that ranges between 2.7% and 20% 3, 7. Spinal cord ischemia and subsequent infarction as a consequence of temporary or permanent interruption of the vascular supply to the spinal cord during operation has been believed to be the major cause of postoperative paraplegia in this patient population. Distal aortic perfusion, deliberate
Acknowledgements
We acknowledge Elizabeth Hoel and William Moser for their assistance in managing the aortic surgical database used in this study. We also wish to acknowledge the nursing staff of the Cardiothoracic Surgical Intensive Care Unit for their dedication to the project and attention to the early identification of patients with postoperative paraplegia. The study was unfunded.
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