Spinal cord protection during a thoracoabdominal aortic repair for a chronic type B aortic dissection using the aortic tailoring strategy.
This study evaluated the clinical advantage of a novel technique to reconstruct a true lumen with aortic wall tailoring for aortic repair (aortic tailoring) or the reimplantation of intercostal arteries (vascular tube) in a chronic type B aortic dissection. Thirty-three consecutive extended thoracoabdominal aortic repairs have been performed for chronic type B dissection since 2000. The novel strategy was applied in 17 cases since 2004 including eight cases of aortic repair (group A) and nine cases of a vascular tube (group B). The other 16 cases were graft interposition in five and no reimplantation in 11 for group C. There were no surgical deaths in either group A or B, and only one late death in group C. No patients sustained transient or permanent paraplegia in group A and B, while three cases of paraplegia occurred in group C (18.8%). All of the intercostal arteries were well preserved in group A and an average of 9.8 intercostal arteries for nine patients were reimplantated in group B. The present technique can optimally preserve the intercostal arteries maximally and showed an excellent surgical mortality and morbidity, especially with regard to the protection of the spinal cord.
Mutsuga
Masato
M
Graduate School of Medicine, Department of Cardiac Surgery, Nagoya University, 65 Tsurumaicyo Syowaku, Nagoya, Aichi 466-8550, Japan. mutsuga@med.nagoya-u.ac.jp
Narita
Yuji
Y
Araki
Yoshimori
Y
Maekawa
Atsuo
A
Oshima
Hideki
H
Usui
Akihiko
A
Ueda
Yuichi
Y
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology / Q000517:prevention & control*; D012092:Replantation; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply*; D020760:Spinal Cord Ischemia / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome