Systemic temperature and paralysis after thoracoabdominal and descending aortic operations.
OBJECTIVE
Systemic temperature influences the development of neurologic deficits after aortic surgery.


METHODS
Retrospective case-comparison study of prospectively collected data.


METHODS
Tertiary referral center.


METHODS
We examined spinal cord injury according to mild passive hypothermia (mean temperature, 36.5 degrees C; n = 25), moderate active hypothermia (temperature range, 29 degrees C-32 degrees C; n = 76), or profound hypothermia (temperature, <20 degrees C; n = 31) for complex repairs in 132 patients. Aortic dissection was present in 67 patients (51%), 41 (31%) had leaks or rupture, 39 (30%) were reoperations on the descending thoracic aorta, and 27 (20%) had concurrent arch and/or ascending thoracic aortic repairs.


METHODS
Occurrence of permanent and transient deficits.


RESULTS
Five patients (3.8%) had permanent deficits. One (4.0%) of the 25 patients underwent mild hypothermia, 3 (3.9%) of the 76 patients who underwent moderate hypothermia, and 1 (3.2%) of the 31 patients who underwent profound hypothermia (P =.70). Reversible deficits occurred in 7 patients (total 32%) who underwent mild hypothermia, 2 patients (total 6.6%) underwent moderate hypothermia, and 1 (total 6.5%) underwent profound hypothermia (P =.004). Six were delayed neurologic deficits. Independent predictors were intercostal ischemic time (P =.02), mild hypothermia (P =.004), and no cerebrospinal fluid drainage (P =.05). The total 30-day survival was 92.4% (122 of 132 patients). The only multivariable predictor of death was acuity of surgery (namely, emergent, urgent, or elective) (P =.06).


CONCLUSIONS
Moderate or profound hypothermia resulted in fewer transient neurologic deficits. Thus, we recommend active cooling and cerebrospinal fluid drainage for most patients, and profound hypothermia for patients undergoing complex repairs and reoperations.
Svensson
Lars G
LG
Center for Aortic Surgery, Marfan and Connective Tissue Disorder Clinic, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, Ohio 44195, USA. svenssl@ccf.org
Khitin
Lev
L
Nadolny
Edward M
EM
Kimmel
Wendy A
WA
D001012:Aorta, Abdominal / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D010264:Paraplegia / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000401:mortality / Q000503:physiopathology*