NEUROLOGIC DEFICIT IN PATIENTS AT HIGH-RISK WITH THORACOABDOMINAL AORTIC-ANEURYSMS - THE ROLE OF CEREBRAL SPINAL-FLUID DRAINAGE AND DISTAL AORTIC PERFUSION

Purpose: This prospective study evaluated the possible prevention of p ostoperative neurologic deficit in patients at high risk with thoracoa bdominal aortic aneurysms (TAAA), types I and II, by use of perioperat ive cerebrospinal fluid drainage and distal aortic perfusion. Methods: Between September 18, 1992, and August 8, 1993, 45 consecutive patien ts underwent TAAA repair (14 type I, 31 type II). Thirty-six were men and nine were women. The median age was 63 years (range 28 to 88). Twe nty-four of 45 patients (53%) had dissection and 17 of 45 (38%) had pr ior proximal aortic replacement. Ah patients underwent perioperative c erebrospinal fluid drainage and distal aortic perfusion. Median aortic clamping time was 42 minutes. Thirty-five of 45 patients (78%) underw ent intercostal artery reattachment. Results: The 30-day survival rate was 96% (43 of 45 patients). Early neurologic deficit occurred in two of 45 patients (4%), and late neurologic deficit also occurred in two of 45 patients (4%). We compared the neurologic deficit of our curren t group of 45 patients with the data of a previously unpublished study of 112 patients also from this center. Total neurologic deficit for t he current group was four of 45 (9%) versus the previous group of 35 o f 112 (31%) with ap value of 0.0034 (Pearson chi-square test). Neurolo gic deficit for patients with type I TAAA was 0 of 14 (0%) versus 15 o f 73 (21%) (P = 0.062); for patients with type II TAAA 4 of 31 (13%) v ersus 20 of 39 (51%) (p = 0.0008). In patients with aortic dissection, neurologic deficit was 3 of 24 (12%) versus 9 of 32 (28%) (p = 0.0304 ); no dissection was 1 of 21 (5%) versus 26 of 80 (32%) (p = 0.011). F or aortic clamp times less than 45 minutes, neurologic deficit was 1 o f 24 (4%) versus 14 of 68 (21%) (P = 0.061); for aortic clamp times eq ual to or greater than 45 minutes, neurologic deficit was 3 of 21 (14% ) versus 21 of 44 (48%) (P = 0.0090). Conclusion: Neurologic deficit i n patients treated for types I and ZI TAAA was reduced significantly b y perioperative cerebral spinal fluid drainage and distal aortic perfu sion.