Improved outcome in thoracoabdominal aortic aneurysm repair: the role of cerebrospinal fluid drainage.
BACKGROUND
To evaluate the protective effect and the optimum duration of cerebrospinal fluid drainage (CSFD) during and after thoracoabdominal aortic aneurysm (TAAA) repair.


METHODS
From April 2001 to October 2003, we retrospectively compared 17 (n = 17) consecutive patients who have been electively operated on by Martin Grabenwoger for left heart bypass and selective perfusion of the visceral and renal organs.


RESULTS
The first 7 patients had CSFD for 72 hours; the duration of CSFD was increased to 100 hours in the remaining 10 patients. Median drained cerebrospinal fluid (CSF) volume was 680 milliliters in the 72-hour group versus 1441 milliliters in the 100-hour group. A characteristic increase in CSF volume was noted between POD No. 2 and POD No. 4 indicating persistent spinal cord edema. Univariate and multivariate analysis demonstrated that CSFD for 100 hours is a significant predictor for decreased incidence of late onset paraplegia (p < 0.001). The overall incidence of postoperative neurological deficit was 17.6% (3 of 17). There was one patient (6%) who developed permanent paraplegia and two patients (12%) with transient paraplegia. These patients sustained late-onset paraplegia 72 hours after surgery for removal of a CSFD device. Complete motor function could be restored after re-insertion of a CSFD device. In one patient, permanent paraplegia was evident after awakening from anesthesia. Because of technical difficulties, only two intercostal arteries could be re-implanted, which was obviously not sufficient to restore spinal cord perfusion. In contrast, no neurological deficit occurred in patients in whom a CSFD instrument was left for 100 hours.


CONCLUSIONS
The extended duration of CSFD may lower the risk of late-onset paraplegia and could improve outcome in patients undergoing thoracoabdominal aortic surgery.
Fleck
Tatjana M
TM
Department of Cardiothoracic Surgery, University of Vienna,Vienna, Austria. t9204604@hotmail.com
Koinig
Herbert
H
Moidl
Reinhard
R
Czerny
Martin
M
Hamilton
Carole
C
Schifferer
Arno
A
Jelen
Marian
M
Wolner
Ernst
E
Grabenwoger
Martin
M
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002555:Cerebrospinal Fluid; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D018611:Heart Bypass, Left; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome