Thorac Cardiovasc Surg
DOI: 10.1055/s-0040-1708470
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Surgical Thoracoabdominal Aortic Aneurysm Repair in a Non-High-Volume Institution

1  Department of Cardiac Surgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
,
Claudia Vukic
2  Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
,
Fumihiro Sata
3  Health Center, Chuo University, Tokyo, Japan
,
Hans-Jaochim Schäfers
2  Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
› Author Affiliations
Further Information

Publication History

01 October 2019

14 January 2020

Publication Date:
12 April 2020 (online)

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.

Disclosure

All the authors have nothing to disclose with regard to commercial support.