1. Neurologic deficit in patients at high risk with thoracoabdominal aortic aneurysms: the role of cerebral spinal fluid drainage and distal aortic perfusion
- Author
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Victor M. Rivera, Harold K. Doerr, Hazim J. Safi, Ghazala R. Butt, Robert Maulsby, Stefano Bartoli, Roy Sheinbaum, Joseph R. Viets, Kenneth R. Hess, and Salwa S. Shenaq
- Subjects
Adult ,Male ,medicine.medical_specialty ,Aneurysm ,Postoperative Complications ,Risk Factors ,medicine.artery ,medicine ,Thoracic aorta ,Humans ,Prospective Studies ,Survival rate ,Aged ,Aortic dissection ,Aged, 80 and over ,Postoperative Care ,Intraoperative Care ,Aortic Aneurysm, Thoracic ,business.industry ,Vascular disease ,Incidence ,Abdominal aorta ,Perioperative ,Infusion Pumps, Implantable ,Middle Aged ,medicine.disease ,Constriction ,Cerebrospinal Fluid Shunts ,Surgery ,Survival Rate ,Aortic Dissection ,Anesthesia ,Multivariate Analysis ,Reperfusion ,Drainage ,Regression Analysis ,Female ,Nervous System Diseases ,Cardiology and Cardiovascular Medicine ,business ,Intercostal arteries ,Aortic Aneurysm, Abdominal - Abstract
Purpose: This prospective study evaluated the possible prevention of postoperative neurologic deficit in patients at high risk with thoracoabdominal aortic aneurysms (TAAA), types I and II, by use of perioperative cerebrospinal fluid drainage and distal aortic perfusion. Methods: Between September 18, 1992, and August 8, 1993, 45 consecutive patients underwent TAAA repair (14 type I, 31 type II). Thirty-six were men and nine were women. The median age was 63 years (range 28 to 88). Twenty-four of 45 patients (53%) had dissection and 17 of 45 (38%) had prior proximal aortic replacement. All patients underwent perioperative cerebrospinal fluid drainage and distal aortic perfusion. Median aortic clamping time was 42 minutes. Thirty-five of 45 patients (78%) underwent intercostal artery reattachment. Results: The 30-day survival rate was 96% (43 of 45 patients). Early neurologic deficit occurred in two of 45 patients (4%), and late neurologic deficit also occurred in two of 45 patients (4%). We compared the neurologic deficit of our current group of 45 patients with the data of a previously unpublished study of 112 patients also from this center. Total neurologic deficit for the current group was four of 45 (9%) versus the previous group of 35 of 112 (31%) with a p value of 0.0034 (Pearson chi-square test). Neurologic deficit for patients with type I TAAA was 0 of 14 (0%) versus 15 of 73 (21%) (p = 0.062); for patients with type II TAAA 4 of 31 (13%) versus 20 of 39 (51%) (p = 0.0008). In patients with aortic dissection, neurologic deficit was 3 of 24 (12%) versus 9 of 32 (28%) (p = 0.0304); no dissection was 1 of 21 (5%) versus 26 of 80 (32%) (p = 0.011). For aortic clamp times less than 45 minutes, neurologic deficit was 1 of 24 (4%) versus 14 of 68 (21%) (p = 0.061); for aortic clamp times equal to or greater than 45 minutes, neurologic deficit was 3 of 21 (14%) versus 21 of 44 (48%) (p = 0.0090). Conclusion: Neurologic deficit in patients treated for types I and II TAAA was reduced significantly by perioperative cerebral spinal fluid drainage and distal aortic perfusion. (J VASC SURG 1994;20:434-43.)
- Published
- 1994