title: Neurologic outcomes from high risk descending thoracic and thoracoabdominal aortic operations in the era of endovascular repair.
abstract: BACKGROUND
  Spinal cord ischemia and stroke are recognized complications of descending thoracic (DTA) and thoracoabdominal aortic (TAA) operations. However, there are limited data available on outcomes since the advent of thoracic endovascular aortic repair (TEVAR).
  
  
  METHODS
  We reviewed charts from consecutive patients who underwent open DTA and TAA operations, excluding type IV repair, from January, 2000 through April, 2005.
  
  
  RESULTS
  A total of 224 open DTA and TAA operations were included in the analysis. During this period 108 additional patients received TEVAR, accounting for 66% of all DTA repairs. Among the 224 patients who underwent open surgery, 63 patients (28%) developed spinal ischemia postprocedure, 13 (6%) had a stroke, and 9 (4%) had both. The 30 day in-hospital mortality was 18%. Neurologic complications were strongly associated with mortality: 64% of patients with stroke died compared to 17% without (P < 0.001) and 39% of patients with spinal ischemia died compared to 14% without (P < 0.001). At discharge, 29% had a poor outcome from surgery, defined as death or moderate-to-severe neurologic disability. A multivariable logistic regression incorporating characteristics known prior to surgery resulted in a score to stratify risk of poor outcome by giving one point each for age > or =60, history of cerebrovascular disease, Crawford extent II or III repair, and acute rupture. Patients with score > or =3 had an estimated 60% risk for poor outcome, while those with score < or =1 had an estimated risk of 7-11%.
  
  
  CONCLUSIONS
  Ischemic neurologic complications were frequent and strongly associated with poor outcomes after open DTA and TAA repair among patients not eligible for TEVAR. Risk of death or neurologic disability can be estimated based on factors known prior to surgery.
authors.affiliation: Department of Neurology, Hospital of the University of Pennsylvania, University of Pennsylvania Medical Center, 3W Gates Building, 3400 Spruce Street, Philadelphia, PA 19104, USA. messe@mail.med.upenn.edu
authors.forename: Steven R
authors.initials: SR
authors.lastname: Messé
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.forename: Michael
authors.initials: M
authors.lastname: Mullen
authors.forename: Albert T
authors.initials: AT
authors.lastname: Cheung
authors.forename: Rebecca
authors.initials: R
authors.lastname: Davis
authors.forename: John G
authors.initials: JG
authors.lastname: Augoustides
authors.forename: Jacob
authors.initials: J
authors.lastname: Gutsche
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Woo
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
authors.forename: Y Joseph
authors.initials: YJ
authors.lastname: Woo
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kasner
authors.forename: Michael
authors.initials: M
authors.lastname: McGarvey
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D017130:Angioplasty; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D020760:Spinal Cord Ischemia / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology*; D016896:Treatment Outcome