title: Spinal cord protection during open repair of thoracic and thoracoabdominal aortic aneurysms using profound hypothermia and circulatory arrest.
abstract: BACKGROUND
  Reduced risk of paraplegia is argued as an advantage of endovascular repair of descending thoracic aortic aneurysms (DTA) and thoracoabdominal aortic aneurysms (TAAA); however, paraplegia rates with open repair vary widely.
  
  
  METHODS
  We identified consecutive patients undergoing open repair of TAAA or DTA with or without arch replacement using profound hypothermia and circulatory arrest as a spinal cord protection strategy on a single surgical service between June 1, 2001 and September 20, 2010.
  
  
  RESULTS
  Ninety-nine procedures were performed in 94 patients with a mean age of 59 years (range 19 to 84 years), 56 of whom were male (60%). The extent of repair was TAAA in 37 (Crawford extent I in 6, extent II in 28, and extent III in 3), DTA in 37, and DTA plus arch in 25. Surgery was urgent or emergent in 25 patients (25%). Operative mortality (30-day) was 10% (10 of 99), including a mortality of 12% for arch DTA (3 of 26), 11% for TAAA (4 of 25), and 5% for isolated DTA (2 of 37). There were 11 (11%) strokes and 11 patients experienced renal failure (7 with dialysis). There were 15 late deaths and survival at 5 years was 74% (95% CI, 62.4-88.2%). No patients experienced paraplegia, although one had delayed paraparesis thought to be secondary to refractory hypotension postoperatively.
  
  
  CONCLUSIONS
  Although the mortality and stroke risks for patients undergoing repair of DTA or TAAA using profound hypothermia and circulatory arrest are substantial, the risk for paraplegia is low. In appropriately selected patients, profound hypothermia and circulatory arrest should be the preferred technique for spinal cord protection for DTA and TAAA.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic Rochester, Rochester, MN, USA. tsundt@partners.org
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.forename: Mark D
authors.initials: MD
authors.lastname: Fleming
authors.forename: Mark D
authors.initials: MD
authors.lastname: Flemming
authors.forename: Gustavo S
authors.initials: GS
authors.lastname: Oderich
authors.forename: Norman E
authors.initials: NE
authors.lastname: Torres
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Li
authors.forename: Judy
authors.initials: J
authors.lastname: Lenoch
authors.forename: Manju
authors.initials: M
authors.lastname: Kalra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D055815:Young Adult