Spinal cord protection in descending thoracic and thoracoabdominal aortic repair

Background. During simple cross-clamp repair of the descending thoracic or thoracoabdominal aorta, the likelihood of neurologic complications increases greatly after only 30 minutes of spinal cord ischemia. At greatest risk are patients with type II thoracoabdominal aortic aneurysms. Methods. We reviewed our experience of simple crossclamp repair and procedures accompanied by adjuncts, paying particular attention to the outcome of patients who had type II thoracoabdominal aortic aneurysms. Between February 1991 and March 1998, 508 patients had descending thoracic and thoracoabdominal aortic repair, 255 (50.2%) of whom received the adjuncts of cerebrospinal fluid drainage and distal aortic perfusion. Results. Fifteen patients died on the day of operation and could not be evaluated for neurologic deficit. The overall incidence of neurologic deficit was 33 of 493 patients (6.7%). In patients who received adjuncts, neurologic deficit occurred in 9 of 247 (3.6%) overall; in types I and II it was 8 of 164 (4.9%), and in type II alone, 7 of 87 (8.1%). Neurologic deficit in simple cross-clamp patients was 24 of 246 (9.8%) overall; in types I and II it was 15 of 99 (15.2%), and in type II alone, 13 of 44 (29.6%;). Conclusions. With the surgical adjuncts of cerebrospinal fluid drainage and distal aortic perfusion, the probability of neurologic deficit is lowered appreciably. (C) 1999 by The Society of Thoracic Surgeons.