Descending thoracic aortic aneurysm: Surgical approach and treatment usingthe adjuncts cerebrospinal fluid drainage and distal aortic perfusion

Background. Neurologic deficit (paraplegia or paraparesis) remains a signif icant morbidity in the repair of descending thoracic aortic aneurysm. Methods. Between February 1991 and February 2000, we operated on 182 patien ts for descending thoracic aortic aneurysm. For the purpose of this study-t o identify the impact of the combined adjuncts distal aortic perfusion and cerebrospinal fluid (CSF) drainage on neurologic outcome-we selected the 14 8 of 182 nonemergent patients who had received conventional treatment (simp le cross-clamping with or without adjuncts). The mean patient age was 61 ye ars, and 49 of the 148 (33%) patients were women. Nine of the 148 patients (6%) had acute type B dissections. We compared the results of 105 of the 14 8 patients (71%) who received the combined adjuncts of CSF drainage and dis tal aortic perfusion with the remaining 43 (29%) patients who underwent rep air using the simple cross-clamp with or without the addition of a single a djunct. Results. Overall 30-day mortality was 13 of 148 patients (8.8%). Overall ea rly neurologic deficit was 4 of 148 (2.7%): 1 of 105 (0.9%) patients who ha d received distal aortic perfusion and CSF drainage, versus 3 of 43 (7%) in all other patients (p < 0.04). Conclusions. In our practice the use of the combined adjuncts of CSF draina ge and distal aortic perfusion has all but eliminated the incidence of imme diate postoperative neurologic deficit in nonemergent patients with aneurys ms of the descending thoracic aorta. (C) 2001 by The Society of Thoracic Su rgeons.