Neurologic outcome after thoracic and thoracoabdominal aortic aneurysm repair

Background. Neurologic deficit (paraparesis and paraplegia) after repair of the thoracic and thoracoabdominal aorta remains a devastating complication . The purpose of this study was to determine the effect of cerebrospinal fl uid drainage and distal aortic perfusion upon neurologic outcome during rep air of thoracic and thoracoabdominal aortic aneurysm (TAAA) repair. Methods. Between February 1991 and March 2000, we performed 654 repairs of the thoracic and thoracoabdominal aorta. The median age was 67 years and 42 0 (64%) patients were male. Forty-five cases (6.9%) were performed emergent ly. Distribution of TAAA was the following: extent I, 164 (25%); extent II, 165 (25%); extent III, 61 (9%); extent IV, 95 (15%); extent V, 23 (3.5%); and descending thoracic, 147 (22%). The adjuncts cerebrospinal fluid draina ge and distal aortic perfusion were used in 428 cases (65%). Results. Thirty-day mortality was 14% (94 of 654). The in-hospital mortalit y was 16% (106 of 654). Early neurologic deficits occurred in 33 patients ( 5.0%). Overall, 14 of 428 (3.3%) neurologic deficits were observed in the a djunct group, and 19 of 226 (8.4%) in the nonadjunct group (P = 0.004). Whe n the adjuncts were used during extent II repair, the incidence was 10 of 1 29 (7.8%) compared with 11 of 36 (30.6%) in the nonadjunct group (p < 0.001 ). Multivariate analysis demonstrated that risk factors for neurologic defi cit were cerebrovascular disease and extent of TAAA (II and III) (p < 0.05) . Conclusions. The combined adjuncts of distal aortic perfusion and cerebrosp inal fluid drainage demonstrated improved neurologic outcome with repair of thoracic and TAAAs. In extent II aneurysms, adjuncts continue to make a co nsiderable difference in the outcome and to provide significant protection against spinal cord morbidity. Future research should focus on spinal cord protection in patients with high-risk extent II aneurysms. (C) 2001 by The Society of Thoracic Surgeons.