Spinal Cord Protection in Descending and Thoracoabdominal Aortic Surgery - The Role of Distal Perfusion

Abstract

The use of distal perfusion in descending thoracic and thoracoabdominal aortic surgery remains a controversial issue. Few mainly retrospective studies which directly compare simple clamping with distal perfusion are available. The aim of the present study was such a comparison in an own series of descending and thoracoabdominal aortic replacement. The records of 29 patients who underwent descending or thoracoabdominal aortic replacement between 1988 and 1994 were retrospectively reviewed. Patients were divided into two groups. Croup I consisted of 14 patients who received aortic replacement using simple clamping, group II was represented by 15 patients who were operated with distal perfusion techniques. In group II left heart bypass with a centrifugal pump was used in 3 patients, and partial cardiopulmonary bypass with a roller pump in 12 patients. The paraplegia/paraparesis rate was 28.6% in group I and 0.0% in group II (p = 0.0258). There were no statistically significant differences regarding surgical revision for bleeding (14.3% in group 1,14.0% in group II), postoperative renal failure (14.3% in group I,13.3% in group II), postoperative Ventilator dependence (9.0 days in group 1,11.2 days in group II), rate of postoperative multisystem organ failure (26.7% in group I, 33.3% in group II), length of stay in the ICU (13.6 days in group I and 13.9 days in group II), and 30-day mortality (21.4% in group I and 33.3 % in group II). Methods of distal perfusion in comparison to simple clamping can lead to a lower paraplegia/paraparesis rate in descending and thoracoabdominal aortic surgery.

Key words

Descending aorta - Thoracoabdominal aorta - Aortic cross-clamping - Distal perfusion - Spinal cord injury