Spinal cord deficit after 1114 extent II open thoracoabdominal aortic aneurysm repairs

Coselli, Joseph S.; Green, Susan Y.; Price, Matt D.; Zhang, Qianzi; Preventza, Ourania; Cruz, Kim I. de la; Whitlock, Richard S.; Amarasekara, Hiruni S.; Woodside, Sandra J.; Perez-Orozco, Andre; LeMaire, Scott A.

doi:10.1016/j.jtcvs.2019.01.120

Cited by 48 publications

(51 citation statements)

References 25 publications

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“…Another important way to protect the spinal cord is to sustain perfusion of the spinal cord via reattached intercostal or lumbar arteries during and after aortic surgery. In a study of 1,114 extent II repairs, reattachment of at least one pair of intercostal or lumbar arteries protected against persistent paraplegia or paraparesis, with a relative risk reduction of 0.38 (P<0.001) (21). However, reattaching intercoastal and lumbar arteries to prevent spinal cord complications is a controversial topic.…”

Section: Spinal Cord Protectionmentioning

confidence: 99%

Narrative review: open surgery for thoracoabdominal aortic aneurysm—is it still a horrible surgery?

Kothari¹,

Weldon²,

Köksoy³

et al. 2022

J Vis Surg

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With the introduction of endovascular stent graft technology, options are available for treating patients with thoracoabdominal aortic aneurysms (TAAAs). However, open repair, despite its invasiveness, is still considered the gold standard for managing TAAA. Because this operation necessitates a large incision and is associated with life-threatening operative risk and serious life-altering postoperative complications such as paraplegia and renal failure, open repair may be described with ominous adjectives such as terrifying or horrible. Even large-volume centers of excellence have a relatively high incidence of mortality and morbidity, which contributes to the serious reputation of this surgery. However, over the years, steps have been taken to help mitigate risks in open repair, including the use of left heart bypass, cerebrospinal fluid drainage, cold renal perfusion, and reimplantation of intercostal and lumbar arteries, and early outcomes have generally improved. Late durability of open repair is well established. Endovascular repair of less complex descending thoracic aortic aneurysms is widely considered a good alternative to open surgical repair;notably, these are aneurysms that do not involve the visceral arteries. Experimental endovascular approaches for repairing TAAAs are emerging, but a substantial subset of patients may remain better suited for open repair because of anatomic and other limitations as well as some significant risks that are associated with endovascular repair. Endovascular repair of aneurysms involving visceral branches may be challenging even with fenestrated or branched endovascular graft technology. For many patient groups undergoing TAAA repair, protective adjuncts and overall durability have imparted significant benefits and support the continued need for open repair, making it far from a horrible surgery.

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Section: Spinal Cord Protectionmentioning

confidence: 99%

Narrative review: open surgery for thoracoabdominal aortic aneurysm—is it still a horrible surgery?

Kothari¹,

Weldon²,

Köksoy³

et al. 2022

J Vis Surg

Self Cite

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“… 6 CSFD works by lowering the intrathecal pressure and augmenting spinal cord perfusion. The effectiveness of CSFD in reducing SCI has been demonstrated in multiple observational series 2 , 6 , 7 , 8 , 9 , 10 and a randomized trial. 11 Both the American Heart Association 12 and the European Association for Cardiothoracic Surgery 13 guidelines recommend CSFD for patients at high risk of SCI undergoing open and endovascular TAAA repair.…”

Section: Rationale For Csfd Usementioning

confidence: 99%

Commentary: Cerebrospinal fluid drainage: One component of a successful distal aortic surgery program

et al. 2021

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“…Spinal cord ischemia is one of the most serious complications of aortic repair in patients with acute aortic syndrome, occurring in approximately 3-16% of cases following open surgery or thoracic endovascular aortic repair (TEVAR) [1][2][3]. Spinal cord ischemia following aortic repair is caused by numerous factors [4].…”

Section: Introductionmentioning

confidence: 99%

Profound Hypotension before Aortic Clamping Can Exacerbate Spinal Cord Ischemic Injury after Aortic Surgery in Rats

Koo

Ryu

Hwang

et al. 2020

JCM

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Spinal cord ischemia is one of the most serious complications of aortic repair in patients with acute aortic syndrome. However, the effect of hypotension before aortic clamping on spinal cord injury has not been documented. A total of 48 male Sprague-Dawley rats were randomly divided into four groups: the sham group; control group (mean arterial pressure (MAP) < 90% of baseline value before aortic clamping); mild hypotension group (MAP < 80%); and profound hypotension group (MAP < 60%). Spinal cord ischemia was induced using a balloon-tipped catheter placed in the descending thoracic aorta. Neurological function of the hind limbs was evaluated for seven days after reperfusion and recorded using a motor deficit index (MDI). The spinal cord was then harvested for histopathological examination and evaluation of oxidative stress and inflammation. The profound hypotension group demonstrated a significantly higher MDI 48 h post-reperfusion and lower number of normal motor neurons than the other groups (p < 0.001). The levels of tissue malondialdehyde and tumor necrosis factor-α (TNF-α) were also significantly increased in the profound hypotension group compared with other groups. Profound hypotension before aortic clamping can aggravate neurologic outcomes after aortic surgery by exacerbating neurologic injury and reducing the number of normal motor neurons.

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Spinal cord deficit after 1114 extent II open thoracoabdominal aortic aneurysm repairs

Cited by 48 publications

References 25 publications

Narrative review: open surgery for thoracoabdominal aortic aneurysm—is it still a horrible surgery?

Narrative review: open surgery for thoracoabdominal aortic aneurysm—is it still a horrible surgery?

Commentary: Cerebrospinal fluid drainage: One component of a successful distal aortic surgery program

Profound Hypotension before Aortic Clamping Can Exacerbate Spinal Cord Ischemic Injury after Aortic Surgery in Rats

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