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Spinal Cord Deficit After 1114 Extent II Open Thoracoabdominal Aortic Aneurysm Repairs

Wednesday, February 13, 2019

Submitted by

Wei-Guo Ma

Source

Source Name: The Journal of Thoracic and Cardiovascular Surgery

Source URL: https://doi.org/10.1016/j.jtcvs.2019.01.120

Author(s)

Joseph S. Coselli, Susan Y. Green, Matt D. Price, Qianzi Zhang, Ourania Preventza, Kim I. de la Cruz, Richard Whitlock, Hiruni S. Amarasekara, Sandra J. Woodside, Andre Perez-Orozco, Scott A. LeMaire

In this paper, Dr Coselli and colleagues analyzed their experience with spinal cord deficit (SCD) after 1114 extent II open thoracoabdominal aortic aneurysm repairs performed from 1991-2017.

The incidence of SCD was 13.6% (151 of 1114), 86 (7.7%) with persistent paraplegia or paraparesis (PPP) (51 paraplegia, 35 paraparesis) and 65 (6.1%) with transient paraplegia or paraparesis. Patients with SCD were older (median 68 versus 65 years old, P<0.001), and they had more rupture (6.6% versus 2.2%, P=0.002) and urgent/emergent repair (25.2% versus 16.8%, P=0.01) than those without. PPP developed immediately in 47 patients (4.2%) and was delayed in 39 (3.5%). Urgent/emergent repair (relative risk ratio [RRR]=2.31, P=0.002), coronary artery disease (RRR=1.80, P=0.01), and chronic symptoms (RRR=1.76, P=0.02) independently predicted PPP. Reattaching intercostal/lumbar arteries (RRR=0.38, P<0.001) and heritable disease (RRR=0.36, P=0.01) were protective. Early and late survival were poorer in those with persistent paraplegia or paraparesis than in those without.

This report adds important data to our knowledge of spinal cord deficit after extent II open TAAA repair, which warrants further studies.