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J Vasc Surg ; 20(3): 434-44; discussion 442-3, 1994 Sep.
Article in English | MEDLINE | ID: mdl-8084037

ABSTRACT

PURPOSE: This prospective study evaluated the possible prevention of postoperative neurologic deficit in patients at high risk with thoracoabdominal aortic aneurysms (TAAA), types I and II, by use of perioperative cerebrospinal fluid drainage and distal aortic perfusion. METHODS: Between September 18, 1992, and August 8, 1993, 45 consecutive patients underwent TAAA repair (14 type I, 31 type II). Thirty-six were men and nine were women. The median age was 63 years (range 28 to 88). Twenty-four of 45 patients (53%) had dissection and 17 of 45 (38%) had prior proximal aortic replacement. All patients underwent perioperative cerebrospinal fluid drainage and distal aortic perfusion. Median aortic clamping time was 42 minutes. Thirty-five of 45 patients (78%) underwent intercostal artery reattachment. RESULTS: The 30-day survival rate was 96% (43 of 45 patients). Early neurologic deficit occurred in two of 45 patients (4%), and late neurologic deficit also occurred in two of 45 patients (4%). We compared the neurologic deficit of our current group of 45 patients with the data of a previously unpublished study of 112 patients also from this center. Total neurologic deficit for the current group was four of 45 (9%) versus the previous group of 35 of 112 (31%) with a p value of 0.0034 (Pearson chi-square test). Neurologic deficit for patients with type I TAAA was 0 of 14 (0%) versus 15 of 73 (21%) (p = 0.062); for patients with type II TAAA 4 of 31 (13%) versus 20 of 39 (51%) (p = 0.0008). In patients with aortic dissection, neurologic deficit was 3 of 24 (12%) versus 9 of 32 (28%) (p = 0.0304); no dissection was 1 of 21 (5%) versus 26 of 80 (32%) (p = 0.011). For aortic clamp times less than 45 minutes, neurologic deficit was 1 of 24 (4%) versus 14 of 68 (21%) (p = 0.061); for aortic clamp times equal to or greater than 45 minutes, neurologic deficit was 3 of 21 (14%) versus 21 of 44 (48%) (p = 0.0090). CONCLUSION: Neurologic deficit in patients treated for types I and II TAAA was reduced significantly by perioperative cerebral spinal fluid drainage and distal aortic perfusion.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Cerebrospinal Fluid Shunts , Infusion Pumps, Implantable , Nervous System Diseases/prevention & control , Postoperative Complications/prevention & control , Reperfusion , Adult , Aged , Aged, 80 and over , Aortic Dissection/complications , Aortic Dissection/mortality , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/mortality , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/mortality , Constriction , Drainage , Female , Humans , Incidence , Intraoperative Care , Male , Middle Aged , Multivariate Analysis , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Postoperative Care , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prospective Studies , Regression Analysis , Risk Factors , Survival Rate
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