Rate of paraplegia in elective descending and thoracoabdominal aortic repair in the modern surgical era

Objectives: The risk of paraplegia is one of the major concerns in the surgical repair of descending and thoracoabdominal aortic pathologies. For specific indications endovascular stent grafts are of great attractiveness and are frequently used with spinal cord ischemia in the range of 3 to 13%. With respect to this background, we reviewed our paraplegia rate in various aortic pathologies undergoing conventional surgical repair.

Methods: From July 1993 to April 2006, 54 patients (mean age: 55±16 years, range 25 to 80 years, 61% males) underwent surgical repair of the descending (n=35, 64.8%) and thoracoabdominal aorta (n=19, 35.2%). Underlying pathologies were: aneurysms (n=50), type A aortic dissection (n=4), type B aortic dissection (n=23), and covered perforation (n=4), respectively.

Results: Most patients were operated using deep hypothermic circulatory arrest. 30-day mortality was 5.6% (n=3). Rate of paraplegia was 3.7% (n=2).

Conclusions: Modern surgical principles for elective descending aortic surgery result in a low postoperative risk of hospital death as well as paraplegia. These findings have to be considered when choosing alternative therapeutical strategies for patients with pathologies of the descending and thoracoabdominal aorta.