Improved outcome after repair of descending and thoracoabdominal aortic aneurysms using modern adjuncts

Objective: To evaluate current strategies to decrease spinal cord and organ dysfunction in patients undergoing repair of descending and thoracoabdominal aneurysms. Methods: We reviewed 94 consecutive cases of descending and thoracoabdominal aortic aneurysm repairs to determine the impact of modern adjuncts on postoperative neurologic deficit and mortality. The adjuncts used in these patients included perioperative cerebrospinal fluid drainage, distal aortic perfusion, reattachment of critical intercostal vessels, permissive hypothermia and hypothermic circulatory arrest with antegrade cerebral perfusion. Between December 1999 and March 2005, 24/94 (26%) patients were operated on for thoracoabdominal aortic aneurysm type I, seven (7%) for type II, 25/94 (27%) for type III or type IV, and 38/94 (40%) for descending thoracic aneurysms. Perioperative parameters were collected for all patients, and analyzed retrospectively. Results: Twenty (21%) of the patients required hypothermic circulatory arrest for conduction of the operation. The postoperative rate of paraplegia was 3% (3/94). One patient developed temporary paraparesis. Overall operative mortality was 10% (9/94). This included 12/94 (13%) patients who underwent surgery emergently for ruptured or contained rupture of aortic aneurysm. Conclusion: Use of perioperative cerebrospinal fluid drainage, distal aortic perfusion and permissive hypothermia result in a low incidence of spinal cord injury and a low operative mortality.