[Strategy for spinal cord protection during thoracoabdominal aortic surgery].
BACKGROUND
Our basic strategy for spinal cord protection during thoracoabdominal aortic surgery has been established since August 1994 such as: 1) distal aortic perfusion using partial cardiopulmonary bypass (32-34 degrees C), 2) multi-segmental sequential clamping, 3) deep hypothermic circulatory arrest when sequential clamping is impossible, 4) evoked spinal cord potential-guided reconstruction of the critical intercostal arteries (preoperative evaluation using multi-detector row computed tomography), 5) cerebrospinal fluid drainage, and 6) administration of naloxone hydrochloride and methylprednisolone. In this paper, we analyzed clinical outcome of thoracoabdominal aortic surgery according to this strategy.


METHODS
We have performed thoracoabdominal aortic surgery for 84 patients (52 male, mean 62 +/- 12 years old) during 1991-2003. Their etiology was 34 dissection, 44 non-dissection degenerative disease, 3 pseudo-aneurysm, and 3 infection. Ten operations were performed urgently and 8 emergently. Crawford's classification (type I/II/III/IV/V) was 17/28/17/13/9 for each type. We used partial cardiopulmonary bypass for 67 cases and deep hypothermic circulatory arrest for 14.


RESULTS
For overall/elective cases (n = 84/66), we experienced 13.1/12.1% of incidence of spinal cord injury (paraplegia/paraparesis) and 8.3/4.5% of in-hospital mortality. Within 65 cases (55 elective) operated after August 1994, they decreased up to 7.7/5.5% (0% in type II) and 4.6/1.8%, respectively. Paraplegia was experienced in 2 patients before and 2 patients (emergent operations due to infective aneurysm) after August 1994 (4.8%). Thus, we have experienced no paraplegia in elective cases after establishment of our strategy.


CONCLUSIONS
Our strategy for spinal cord protection during thoracoabdominal aortic surgery could provide acceptable clinical outcome and seemed justified.
Kunihara
T
T
Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Shiiya
N
N
Yasuda
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002555:Cerebrospinal Fluid; D004322:Drainage; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009270:Naloxone / Q000008:administration & dosage; D010264:Paraplegia / Q000517:prevention & control*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply / Q000503:physiopathology; D020760:Spinal Cord Ischemia / Q000517:prevention & control*; D016896:Treatment Outcome
D009270:Naloxone