Descending Thoracic Aortic Aneurysm Repair: 12-Year Experience Using Distal Aortic Perfusion and Cerebrospinal Fluid Drainage
| Autor: | Eyal E. Porat, Riad Meada, Charles C. Miller, Edward P. Chen, Anthony L. Estrera, Ali Azizzadeh, Thi Thanh Tam Huynh, Hazim J. Safi, Ricardo H. Torres |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Thorax medicine.medical_specialty Adolescent Thoracic aortic aneurysm Aneurysm Paraparesis medicine.artery medicine Humans Thoracic aorta Child Aortic rupture Aged Cerebrospinal Fluid Aged 80 and over Paraplegia Aortic Aneurysm Thoracic business.industry Middle Aged medicine.disease Survival Analysis Abdominal aortic aneurysm Surgery Perfusion Logistic Models Outcome and Process Assessment Health Care Treatment Outcome Anesthesia Descending aorta Multivariate Analysis cardiovascular system Drainage Female Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 80:1290-1296 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2005.02.021 |
| Popis: | The benefit of distal aortic perfusion and cerebrospinal fluid drainage over the "clamp and sew" technique during repairs of the descending thoracic aorta is still being debated. The purpose of this report is to analyze our experience with regard to neurologic deficit (paraplegia and paraparesis) and mortality using the adjuncts of distal aortic perfusion and cerebrospinal fluid drainage.Between February 1991 and September 2004, we repaired 355 descending thoracic aortic aneurysms. Excluded from analysis were 29 patients who required profound hypothermic circulatory arrest as a result of transverse arch involvement and 26 patients with aortic rupture, leaving a group of 300 patients for which outcomes were analyzed. Mean patient age was 67 years, and 102 (34%) of the patients were women. The adjunct group of distal aortic perfusion and cerebrospinal fluid drainage used in 238 (79.3%) patients was compared with a group of 62 patients who underwent simple cross-clamp with or without the addition of a single adjunct. Multivariable data were analyzed by Cox regression.The incidence of neurologic deficit after all repairs was 2.3% (7 of 300 patients). The incidence of neurologic deficit (immediate and delayed) in the adjunct group was 1.3% (3 of 238 patients), and in the nonadjunct group was 6.5% (4 of 62 patients; p0.02). One case of delayed paraplegia occurred in each group. All neurologic deficits occurred in patients with aneurysmal involvement of the entire descending thoracic aorta (extent C; p0.02). Statistically significant predictors for neurologic deficit were the use of the adjunct (odds ratio [OR], 0.19; p = 0.02), previous repaired abdominal aortic aneurysm (OR, 7.0; p = 0.005), type C aneurysm (OR, 13.73; p = 0.02), and cerebrovascular disease history (OR, 4.7; p0.03). Thirty-day mortality was 8% (24 of 300 patients). Significant multivariate predictors of 30-day mortality were preoperative renal dysfunction (OR, 4.6; p0.01) and female sex (OR, 2.9; p0.03).Repairs of the descending thoracic aorta using the adjunct of distal aortic perfusion and cerebrospinal fluid drainage can be performed with a low incidence of neurologic deficit and an acceptable mortality. The use of the adjuncts should be considered during elective repairs of the descending thoracic aorta. |
| Databáze: | OpenAIRE |
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