Abstract
Background Surgical thoracoabdominal aortic aneurysm (TAAA) repair remains challenging. Apart
from mortality, spinal cord injury (SCI) is a dreaded complication. We analyzed our
experience to identify predictors for SCI in a nonhigh-volume institution.
Patients and Methods All patients who underwent TAAA repair between February 1996 and November 2016 (n = 182) were enrolled. Most were male (n = 121; 66.4%), median age was 68 years (range: 21–84). Elective operations were performed
in 153 instances (84.1%). Our approach to minimize SCI includes distal aortic perfusion,
mild hypothermia, identification of the Adamkiewicz artery, and sequential aortic
clamping. Cerebrospinal fluid drainage was introduced in 2001 and liberal use of selective
visceral perfusion in 2006.
Results Early mortality was 12.1%; it was 8.5% after elective procedures. Reduced left ventricular
function, nonelective setting, older age, and longer bypass time were identified as
independent predictors for mortality in multivariable logistic regression model. Permanent
SCI was observed in nine patients (4.9%), of whom seven (3.8%) developed paraplegia.
In a multivariable logistic regression model for paraplegia, peripheral arterial disease
(PAD), Crawford type II repair, smaller body surface area, and era before 2001 were
identified as independent predictors, whereas only PAD was significant for SCI. The
incidence of paraplegia was 13.8% in extensive repair out of the first 91 cases, whereas
it was improved up to 2.7% thereafter.
Conclusion Using an integrated approach, acceptable outcome of TAAA repair can be achieved,
even in a nonhigh-volume center. PAD and extensive involvement of the aorta are strong
independent predictors for spinal cord deficit after TAAA repair.
Keywords
aneurysm - aorta/aortic - neurological - outcomes - spinal cord - surgery - complications
