Staged repair significantly reduces paraplegia rate after extensive thoracoabdominal aortic aneurysm repair

Christian D. Etz, Stefano Zoli, Christoph S. Mueller, Carol A. Bodian, Gabriele Di Luozzo, Ricardo Lazala, Konstadinos A. Plestis, Randall B. Griepp

Research output: Contribution to journalArticle

Abstract

Objective: Paraplegia remains a devastating, and still too frequent, complication after repair of extensive thoracoabdominal aortic aneurysms. Strategies to prevent ischemic spinal cord damage after extensive segmental artery sacrifice-or occlusion, essential for endovascular repair-are still evolving. Methods: Ninety patients who underwent extensive segmental artery sacrifice (median, 13; range, 9-15) during open surgical repair from June 1994 to December 2007 were reviewed retrospectively. Fifty-five patients (mean age, 65 ± 12 years; 49% were male), most with extensive Crawford type II thoracoabdominal aortic aneurysms, had a single procedure (single-stage group). Thirty-five patients (mean age, 62 ± 14 years; 57% were male) had 2 procedures (2-stage group), usually Crawford type III or IV repair after operation for Crawford type I descending thoracic aneurysm. The median interval between the 2-stage procedures was 5 years (3 months to 17 years). There were no significant differences between the groups with regard to age, gender, cause of the aneurysm, hypertension, chronic obstructive pulmonary disease, urgency, previous cerebrovascular accidents, year of procedure, or cerebrospinal fluid drainage. In single-stage procedures, hypothermic circulatory arrest was used in 29% of patients, left-sided heart bypass was used in 40% of patients, and partial cardiopulmonary bypass was used in 27% of patients. Somatosensory-evoked potentials were monitored in all patients, and motor-evoked potentials were monitored in 39% of patients. Cerebrospinal fluid was drained in 84% of patients. Results: Overall hospital mortality was 11.1%. There were no significant differences in mortality, stroke, postoperative bleeding, infection, renal failure, or pulmonary insufficiency between the groups. However, 15% of patients in the single-stage group had permanent spinal cord injury versus none in the 2-stage group (P = .02). The significantly lower rate of paraplegia and paraparesis in the 2-stage group occurred despite a significantly higher number of segmental arteries sacrificed in this group: a median of 14 (11-15) versus 12 (9-15) (P 

Original languageEnglish
Pages (from-to)1464-1472
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume139
Issue number6
DOIs
Publication statusPublished - Jun 2010

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Thoracic Aortic Aneurysm
Paraplegia
Arteries
Aneurysm
Left Heart Bypass
Stroke
Paraparesis
Motor Evoked Potentials
Somatosensory Evoked Potentials
Hospital Mortality
Cardiopulmonary Bypass
Spinal Cord Injuries
Chronic Obstructive Pulmonary Disease
Renal Insufficiency
Cerebrospinal Fluid
Spinal Cord
Thorax
Hemorrhage
Hypertension
Lung

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Staged repair significantly reduces paraplegia rate after extensive thoracoabdominal aortic aneurysm repair. / Etz, Christian D.; Zoli, Stefano; Mueller, Christoph S.; Bodian, Carol A.; Di Luozzo, Gabriele; Lazala, Ricardo; Plestis, Konstadinos A.; Griepp, Randall B.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 139, No. 6, 06.2010, p. 1464-1472.

Research output: Contribution to journalArticle

Etz, CD, Zoli, S, Mueller, CS, Bodian, CA, Di Luozzo, G, Lazala, R, Plestis, KA & Griepp, RB 2010, 'Staged repair significantly reduces paraplegia rate after extensive thoracoabdominal aortic aneurysm repair', Journal of Thoracic and Cardiovascular Surgery, vol. 139, no. 6, pp. 1464-1472. https://doi.org/10.1016/j.jtcvs.2010.02.037
Etz, Christian D. ; Zoli, Stefano ; Mueller, Christoph S. ; Bodian, Carol A. ; Di Luozzo, Gabriele ; Lazala, Ricardo ; Plestis, Konstadinos A. ; Griepp, Randall B. / Staged repair significantly reduces paraplegia rate after extensive thoracoabdominal aortic aneurysm repair. In: Journal of Thoracic and Cardiovascular Surgery. 2010 ; Vol. 139, No. 6. pp. 1464-1472.
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abstract = "Objective: Paraplegia remains a devastating, and still too frequent, complication after repair of extensive thoracoabdominal aortic aneurysms. Strategies to prevent ischemic spinal cord damage after extensive segmental artery sacrifice-or occlusion, essential for endovascular repair-are still evolving. Methods: Ninety patients who underwent extensive segmental artery sacrifice (median, 13; range, 9-15) during open surgical repair from June 1994 to December 2007 were reviewed retrospectively. Fifty-five patients (mean age, 65 ± 12 years; 49{\%} were male), most with extensive Crawford type II thoracoabdominal aortic aneurysms, had a single procedure (single-stage group). Thirty-five patients (mean age, 62 ± 14 years; 57{\%} were male) had 2 procedures (2-stage group), usually Crawford type III or IV repair after operation for Crawford type I descending thoracic aneurysm. The median interval between the 2-stage procedures was 5 years (3 months to 17 years). There were no significant differences between the groups with regard to age, gender, cause of the aneurysm, hypertension, chronic obstructive pulmonary disease, urgency, previous cerebrovascular accidents, year of procedure, or cerebrospinal fluid drainage. In single-stage procedures, hypothermic circulatory arrest was used in 29{\%} of patients, left-sided heart bypass was used in 40{\%} of patients, and partial cardiopulmonary bypass was used in 27{\%} of patients. Somatosensory-evoked potentials were monitored in all patients, and motor-evoked potentials were monitored in 39{\%} of patients. Cerebrospinal fluid was drained in 84{\%} of patients. Results: Overall hospital mortality was 11.1{\%}. There were no significant differences in mortality, stroke, postoperative bleeding, infection, renal failure, or pulmonary insufficiency between the groups. However, 15{\%} of patients in the single-stage group had permanent spinal cord injury versus none in the 2-stage group (P = .02). The significantly lower rate of paraplegia and paraparesis in the 2-stage group occurred despite a significantly higher number of segmental arteries sacrificed in this group: a median of 14 (11-15) versus 12 (9-15) (P ",
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AU - Etz, Christian D.

AU - Zoli, Stefano

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AU - Bodian, Carol A.

AU - Di Luozzo, Gabriele

AU - Lazala, Ricardo

AU - Plestis, Konstadinos A.

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N2 - Objective: Paraplegia remains a devastating, and still too frequent, complication after repair of extensive thoracoabdominal aortic aneurysms. Strategies to prevent ischemic spinal cord damage after extensive segmental artery sacrifice-or occlusion, essential for endovascular repair-are still evolving. Methods: Ninety patients who underwent extensive segmental artery sacrifice (median, 13; range, 9-15) during open surgical repair from June 1994 to December 2007 were reviewed retrospectively. Fifty-five patients (mean age, 65 ± 12 years; 49% were male), most with extensive Crawford type II thoracoabdominal aortic aneurysms, had a single procedure (single-stage group). Thirty-five patients (mean age, 62 ± 14 years; 57% were male) had 2 procedures (2-stage group), usually Crawford type III or IV repair after operation for Crawford type I descending thoracic aneurysm. The median interval between the 2-stage procedures was 5 years (3 months to 17 years). There were no significant differences between the groups with regard to age, gender, cause of the aneurysm, hypertension, chronic obstructive pulmonary disease, urgency, previous cerebrovascular accidents, year of procedure, or cerebrospinal fluid drainage. In single-stage procedures, hypothermic circulatory arrest was used in 29% of patients, left-sided heart bypass was used in 40% of patients, and partial cardiopulmonary bypass was used in 27% of patients. Somatosensory-evoked potentials were monitored in all patients, and motor-evoked potentials were monitored in 39% of patients. Cerebrospinal fluid was drained in 84% of patients. Results: Overall hospital mortality was 11.1%. There were no significant differences in mortality, stroke, postoperative bleeding, infection, renal failure, or pulmonary insufficiency between the groups. However, 15% of patients in the single-stage group had permanent spinal cord injury versus none in the 2-stage group (P = .02). The significantly lower rate of paraplegia and paraparesis in the 2-stage group occurred despite a significantly higher number of segmental arteries sacrificed in this group: a median of 14 (11-15) versus 12 (9-15) (P 

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