Left atrial femoral bypass and cerebrospinal fluid drainage decreases neurologic complications in repair of descending and thoracoabdominal aortic aneurysms

This study was undertaken to evaluate the role of cerebrospinal fluid (CSF) drainage and left atrial to femoral artery (LAFA) bypass in preventing pos toperative neurologic complications for patients who had undergone descendi ng and thoracoabdominal aortic aneurysm (TAAA) repair. LAFA bypass and CSF drainage were used as adjuncts in the treatment of 8 patients with descendi ng and 13 patients with TAAAs (December 1999 to March 2000). LAFA bypass wa s established with the use of a centrifugal Biomedicus pump. Distal flows w ere maintained between 1.5 and 2.5 L/min during the procedures. Mean LAFA b ypass time was 40 (range, 21 to 60 min). The CSF pressure was kept below 10 -12 mmHg during the operations and for the first 72 hr postoperatively. All patients received heparin (1 mg/kg), which was reversed at the completion of the procedure. Passive hypothermia (rectal temperature: 32 degrees -34 d egreesC) was used in all cases. All patent T8-L1 intercostal arteries were reattached to the graft. There were 13 men and 8 women. The median age was 56 years (range, 49 to 78). Chronic aortic dissection was the cause of the aneurysm in 9 patients (43%), trauma in 1 patient (5%), and medial degenera tion in 11 patients (52%), There were four type I (19%), four type II (19%) , and five type III (24%) TAAA. In eight patients (38%) the entire descendi ng thoracic aorta was aneurysmal. Our results showed that the use of CSF dr ainage and LAFA bypass prevents paraplegia/paraparesis after repair of thor acoabdominal and descending thoracic aneurysms.