Spinal cord protection during thoracoabdominal aortic replacement: spinal cord perfusion maintenance.
Spinal cord protection during thoracoabdominal aortic surgery is challenging for surgeons. We performed thoracoabdominal replacement using a strategy for maintaining spinal cord perfusion pressure. Here, we report our experience with this procedure and the surgical outcomes.



Between January 2000 and December 2014, 130 patients [male: 91 (74.6%), female: 39 (25.4%); mean age: 66.6 ± 12.8 years] underwent thoracoabdominal replacement using cardiopulmonary bypass at Hiroshima Shimin Hospital, Japan. The surgical outcomes of these patients were analysed.



The in-hospital mortality rate of all patients was 2.5%. The incidence of postoperative paraplegia was 3.8%. Aortic event-free survival rates at 1, 3 and 5 years were 98.2%, 93.9% and 80.7%, respectively.



The present study suggests that our strategy for maintaining spinal cord perfusion pressure provides acceptable outcomes.
Department of Cardiovascular Surgery, Hiroshima Shimin Hospital, Hiroshima, Japan.
Gaku
G
Uchino
Department of Cardiovascular Surgery, Hiroshima Shimin Hospital, Hiroshima, Japan.
Keiji
K
Yunoki
Department of Cardiovascular Surgery, Hiroshima Shimin Hospital, Hiroshima, Japan.
Naoya
N
Sakoda
Department of Cardiovascular Surgery, Hiroshima Shimin Hospital, Hiroshima, Japan.
Shigeru
S
Hattori
Department of Cardiovascular Surgery, Hiroshima Shimin Hospital, Hiroshima, Japan.
Takuya
T
Kawabata
Department of Cardiovascular Surgery, Hiroshima Shimin Hospital, Hiroshima, Japan.
Munehiro
M
Saiki
Department of Cardiovascular Surgery, Hiroshima Shimin Hospital, Hiroshima, Japan.
Yasufumi
Y
Fujita
Department of Cardiovascular Surgery, Hiroshima Shimin Hospital, Hiroshima, Japan.
Kunikazu
K
Hisamochi
Department of Cardiovascular Surgery, Hiroshima Shimin Hospital, Hiroshima, Japan.
Hideo
H
Yoshida
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000379:methods*; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D007564:Japan / Q000453:epidemiology; D008297:Male; D010477:Perfusion / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply*; D020760:Spinal Cord Ischemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Intercostal artery reconstruction; Paraplegia; Spinal ischaemia; Thoracoabdominal replacement