Japanese perspective in surgery for thoracoabdominal aortic aneurysms

Abstract

Our concept of spinal cord protection, which was based on selective intercostal reconstruction while maximizing spinal cord collateral blood flow, seems justified.

Maintenance of High Blood Pressure and Early Establishment of Pulsatile Blood Flow to the Spinal Cord during Thoracoabdominal Aortic Repair

“…Improved results of open repair for TAAA have been reported for the combination of several important strategies including distal aortic perfusion, moderate hypothermia, sequential aortic clamping, spinal monitoring, CSFD, visceral perfusion, and reconstruction of intercostal and lumbar arteries or AKA [3]- [15]. Despite employing all the above-listed strategies, the outcomes of TAAA operations performed in our hospital before 2011 were quite discouraging, with an 11.1% rate of in-hospital mortality and an 8.3% incidence of postoperative paraplegia among the 36 TAAA patients treated during that period.…”

“…SCI is one of the most serious complications of TAAA surgery, severely affecting prognosis and quality of life. Although many preventive and therapeutic approaches have been proposed [3]- [15], the risk of SCI-related paraplegia cannot be fully eliminated because its underlying mechanism is multifactorial. Some clinical and experimental reports have suggested that augmentation of systemic blood pressure during spinal cord ischemia increases spinal cord blood flow and decreases the risk of postoperative neurologic complications [16] [17] [18].…”

“…However, distal aortic perfusion is usually non-pulsatile and of low pressure, which diminishes its usefulness for improving spinal cord perfusion [19]. Moreover, SCI may develop when aortic cross-clamping is prolonged [15]. Therefore, to reduce the risk of postoperative paraplegia, it is desirable to minimize spinal cord ischemia during TAAA repair.…”

Pretreatment With Diazoxide Attenuates Spinal Cord Ischemia-Reperfusion Injury Through Signaling Transducer and Activator of Transcription 3 Pathway

“…(Ann Thorac Surg 2019;107:733-9) Ó 2019 by The Society of Thoracic Surgeons D elayed paraplegia is a devastating complication after thoracoabdominal aortic interventions. The incidence of paraplegia ranges from 5% to 20% [1][2][3]. Although various surgical strategies have advanced, there is no widely recognized pharmacotherapy available to protect the spinal cord.…”

Synergistic Reduction of Apoptosis With Diazoxide and Erythropoietin in Spinal Cord Ischemic Injury

“…(Ann Thorac Surg 2018;106:1751-8) Ó 2018 by The Society of Thoracic Surgeons P araplegia after thoracoabdominal aortic repair remains a devastating complication, occurring in 7% to 20% of thoracoabdominal interventions [1,2]. Despite the advancement of surgical strategies to protect the spinal cord, no pharmacologic therapy currently available has been shown to effectively prevent this complication [3].…”