[Spinal cord protection during most or all of descending thoracic or thoracoabdominal aneurysm repair].
OBJECTIVE
The purpose of this study is to evaluate usefulness of perfusion cooling for regional spinal cord hypothermia during most or all of thoracic or thoracoabdominal aneurysm repair.


METHODS
From 1987 to 2003, 103 patients underwent most or all of thoracic or thoracoabdominal aneurysm repair. Forty-eight patients underwent operation using distal aortic perfusion, mild hypothermia and segment sequential repair (group MH). Fifty-five patients underwent the same operation as group MH except epidural perfusion cooling and drainage of cerebrospinal fluid (CSF) [group EC & CSFD]. The aorta was replaced sequentially in segment and several paris of intercostal and lumbar arteries were reconstructed in 2 groups.


RESULTS
Cardiopulmonary bypass time of group MH and group EC & CSFD was averaged 235 and 241 minutes, respectively. The lowest CSF temperature in group EC & CSFD was averaged 24.7 degrees C, and the difference between nasopharyngeal and CSF temperature was averaged 6.4 degrees C. The rate of spinal cord injury of group MH and EC & CSFD was 10.4% and 3.6%, respectively. Hospital mortality of group MH and EC & CSFD was 8.3% and 5.5%, respectively. The incidence of spinal cord injury and hospital mortality of group EC & CSFD were decreased compared to them of group MH.


CONCLUSIONS
We conclude that the perfusion cooling of epidural space and CSF drainage are effective method in reducing postoperative spinal cord injury.
Tabayashi
K
K
Department of Cardiovascular Surgery, Tohoku University School of Medicine, Sendai, Japan.
Takahashi
G
G
Motoyoshi
N
N
Kokubo
H
H
Sakurai
M
M
Oda
K
K
Saiki
Y
Y
Iguchi
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass; D002555:Cerebrospinal Fluid; D004322:Drainage / Q000379:methods*; D004824:Epidural Space; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D020760:Spinal Cord Ischemia / Q000517:prevention & control*; D016896:Treatment Outcome