Impact of Segmental Aortic Clamp and Distal Aortic Perfusion on Postoperative Paraplegia During Thoracoabdominal Aortic Graft Replacement

Abstract

A variety of different measures have been instituted to decrease spinal cord injury during thoracoabdominal aortic aneurym surgery. However, paraplegia is still a most devastating complication. During the past twelve years, 40 consecutive patients were operated on for thoracoabdominal aortic aneurysms at our hospital. The mean age was 56.7 years and the range 22 to 82 years. Eighteen patients had dissecting aneurysms (DeBakey type III in fourteen patients and type I in four patients). Eight patients (20%) had had prior surgical aortic reconstruction. According to Crawford’s classification, 15 patients were type I, 5 were type II, 11 were III and 9 were type IV. A temporary left heart bypass (PA-FV or FA-FV) to maintain an adequate distal organ perfusion pressure and monitor of sensory evoked spinal cord potentials for detection of intraoperative cord injury was used in all patients. The mean number of cross-clamped aortic segments during surgery was 2.5 (range 1 to 5) in the nondissecting group and 3.4 (range 2 to 5) in the dissection group. Reimplantation of intercostal or lumbar arteries was performed in 18 patients (81.8%) in the nondissection group and in 17 patients (94.4%) in the dissection group. During surgery, selective visceral artery perfusion was undergone in 18 patients for organ preservation. The hospital mortality was 10% (4/40), 6.1% for elective cases (2/33) and 28.6% for emergency operations (2/7). Temporary paraparesis occurred in one patient who underwent emergency operation. No neurologic deficit was observed in the remaining patients.