Background. During simple cross-clamp repair of the descending thoracic or
thoracoabdominal aorta, the likelihood of neurologic complications increase
s greatly after only 30 minutes of spinal cord ischemia. At greatest risk a
re patients with type II thoracoabdominal aortic aneurysms.
Methods. We reviewed our experience of simple crossclamp repair and procedu
res accompanied by adjuncts, paying particular attention to the outcome of
patients who had type II thoracoabdominal aortic aneurysms. Between Februar
y 1991 and March 1998, 508 patients had descending thoracic and thoracoabdo
minal aortic repair, 255 (50.2%) of whom received the adjuncts of cerebrosp
inal fluid drainage and distal aortic perfusion.
Results. Fifteen patients died on the day of operation and could not be eva
luated for neurologic deficit. The overall incidence of neurologic deficit
was 33 of 493 patients (6.7%). In patients who received adjuncts, neurologi
c deficit occurred in 9 of 247 (3.6%) overall; in types I and II it was 8 o
f 164 (4.9%), and in type II alone, 7 of 87 (8.1%). Neurologic deficit in s
imple cross-clamp patients was 24 of 246 (9.8%) overall; in types I and II
it was 15 of 99 (15.2%), and in type II alone, 13 of 44 (29.6%;). Conclusio
ns. With the surgical adjuncts of cerebrospinal fluid drainage and distal a
ortic perfusion, the probability of neurologic deficit is lowered appreciab
ly. (C) 1999 by The Society of Thoracic Surgeons.