Risk factors for spinal cord injury in patients undergoing frozen elephant trunk technique for acute aortic dissection

Hori, Daijiro; Kusadokoro, Sho; Adachi, Koichi; Kimura, Naoyuki; Yasuda, Kôichi; Matsumoto, Harunobu; Yamaguchi, Atsushi

doi:10.1007/s11748-019-01196-2

Cited by 10 publications

(10 citation statements)

References 22 publications

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“…Intraoperative risk factors for the development of SCI, such as a core body temperature ≥28 °C during circulatory arrest in combination with a prolonged circulatory arrest time [ 3 ], showed no statistical significance in our study.…”

Section: Discussioncontrasting

confidence: 68%

“…Furthermore, the FET for acute type A aortic dissection was associated with a postoperative SCI rate of 4%. In their study of 31 patients, Hori et al reported 4 cases of postoperative SCI (12.9%) [ 3 ]. In our analysis of 31 patients, 4 developed postoperative SCI after FET for acute type A dissection.…”

Section: Discussionmentioning

confidence: 99%

“…The occlusion of intercostal arteries after FET has been reported as a risk factor for SCI by Kozlov et al [ 15 ]. Hori et al described significant spinal cord perfusion from intercostal arteries originating from the false lumen as a significant risk factor for SCI [ 3 ]. In our analysis, patients who developed SCI suffered a relevant postoperative decrease in the number of total patent intercostal arteries, but the number of vessels originating from the false lumen and the postoperative decrease in arteries originated from the true lumen were not statistically related to SCI ( Figure 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…The frozen elephant trunk technique (FET) combines total aortic arch replacement with the intraoperative stenting of the distal thoracic aorta. Its purpose of achieving the complete thrombosis of the false lumen in the descending aorta may reduce the necessity of further operations to treat the residual false lumen [ 2 ] and provides more favorable remodeling in the descending aorta than other methods [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Spinal Ischemia after Frozen Elephant Trunk for Acute Aortic Dissection: An Observational, Single-Center Study

et al. 2022

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Background: This observational study aimed to evaluate the perioperative risk factors for spinal cord ischemia (SCI) in patients who underwent aortic repair with the frozen elephant trunk technique (FET) after acute aortic Stanford A dissection. Methods: From May 2015 to April 2019, 31 patients underwent aortic arch replacement with the FET technique, and spinal ischemia was observed in 4 patients. The risk factors for postoperative SCI were analyzed. Results: The mean age of patients with acute aortic dissection was 57.1 years, and 29.4% were female. Four patients developed SCI. There were no significant differences in characteristics such as age and body mass index. The female gender was associated with most of the SCI cases in the univariate analysis (75%, p = 0.016). Known perioperative and intraoperative risk factors were not related to postoperative SCI in our study. Patients who developed SCI had increased serum postoperative creatinine levels (p = 0.03). Twenty-four patients showed complete false lumen thrombosis up to zones 3–4, five patients up to zones 5–6 and two patients up to zones 7–9, which correlates with the postoperative development of SCI (p = 0.02). The total number of patent intercostal arteries was significantly reduced postoperatively in SCI patients (p = 0.044). Conclusions: Postoperative acute kidney injury, the reduction in patent intercostal arteries after surgery and the extension of false lumen thrombosis up to and beyond zone 5 may play a significant role in the development of clinically relevant spinal cord injury after FET.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Analysis of Spinal Ischemia after Frozen Elephant Trunk for Acute Aortic Dissection: An Observational, Single-Center Study

et al. 2022

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“…We assumed that the false lumen of the descending aorta at the aortic valve level could be thrombosed and could achieve excellent aortic remodeling because we used long stent grafts (only 90-mm or 120-mm stent grafts). Despite some studies reporting elevated SCI risk with a distal landing zone of Th 7 or greater [18,23], because we used continuous spinal cord perfusion to decrease SCI risk, we were able to safely deploy the FET to Th 8. FET can prompt the false lumen to be thrombosed at the descending aorta because the stent graft helps close the primary entry, and at the mid-term, the true lumen of the descending aorta expanded because of the radial forces exerted by stent graft expansion and the false lumen degenerated with aortic remodeling.…”

Section: Aortic Remodeling With Fet Technique For Aaadmentioning

confidence: 87%

Early and mid-term outcome of frozen elephant trunk using spinal cord protective perfusion strategy for acute type A aortic dissection

Hohri

Yamasaki

Matsuzaki

et al. 2020

Gen Thorac Cardiovasc Surg

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Objective This study aimed to evaluate the prevalence of spinal cord injury in total arch replacement with frozen elephant trunk for acute type A aortic dissection using our spinal cord protection technique. Methods Between January 2013 and December 2017, 33 patients underwent total arch replacement with frozen elephant trunk for acute type A aortic dissection (mean age 67.9 ± 13.3 years). Our spinal cord protection technique involved maintaining extracorporeal circulation through the left subclavian artery in all procedures, using aortic occlusion balloon during distal anastomosis, and inserting frozen elephant trunk above Th 8 with transesophageal echocardiographic guidance. Computed tomography was performed within 1–2 weeks, 12 months, and 36 months postoperatively. We compared the degree of thrombosis of the descending aorta between preoperation and early postoperative period by Fisher’s exact test. Moreover, we evaluated postoperative mortality and mobility (including spinal cord injury) at follow-up. Results The operative mortality within 30 days was 6.1%. Neither paraplegia nor paraparesis was noted. We observed significant thrombosis of the false lumen at the distal arch and aortic valve level of the descending aorta in postoperative early term period (p < 0.01). At mid-term follow-up (mean 33.9 months), survival probability and 3-year freedom from reoperation rates were 93.9 ± 4.1% and 95.0 ± 4.9%, respectively. Conclusions The frozen elephant trunk technique with our spinal protection strategy provides good postoperative outcomes. Our strategy can maintain spinal cord perfusion without complete ischemia time even during lower body ischemia time. Implementation of our spinal protection strategy will help prevent spinal cord injury and dilated downstream aorta.

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Frozen elephant trunk in acute aortic dissection: a literature review

Murana,

Campanini,

Orioli

et al. 2023

Indian J Thorac Cardiovasc Surg

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Risk factors for spinal cord injury in patients undergoing frozen elephant trunk technique for acute aortic dissection

Cited by 10 publications

References 22 publications

Analysis of Spinal Ischemia after Frozen Elephant Trunk for Acute Aortic Dissection: An Observational, Single-Center Study

Analysis of Spinal Ischemia after Frozen Elephant Trunk for Acute Aortic Dissection: An Observational, Single-Center Study

Early and mid-term outcome of frozen elephant trunk using spinal cord protective perfusion strategy for acute type A aortic dissection

Frozen elephant trunk in acute aortic dissection: a literature review

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