Anesthesia in the surgical repair of thoracoabdominal aneurysms: 17 years experience

Objective: To review the results after thoracoabdominal aortic aneurysms repair performed by the same team of surgeons and anesthesiologists over a 17 year period. Material and methods: A prospective and observational study carried out on 65 patients (97%male) who were operated on from 1995 until July 2011 for thoracoabdominal aneurysm, Crawford type I 5 (7.6%), II 22 (33.8%), III 17 (26.11%) and Iv 21 (32.31%). Results: The 30-day mortality was 9.2% (6/65 patients), which was the same as the incidence of paraplegia. This complication only occurred in the Crawford types ii and iii aneurysms. Paraplegia was present in 4.5% (1/22) of patients in whom "left bypass'' was used, compared with 29% (5/17) in which the intervention was performed by cross-clamping without distal aortic perfusion (P=.068). The most frequent complication was respiratory, with prolonged mechanical ventilation (>48 h) in 20% (13 patients) of cases. The mean hospital stay was 28 days (7-92). Discussion: The average mortality in referral centers is 9.7%, ranging between 5% and 16%. In other centres the mortality at 30 days is between 19% and 31% per year. Our group had a 9.2% of mortality rate at 30 days. The incidence of paraplegia in hospitals with greater experience ranges between 2.7% and 16%. Nowadays, an incidence of less than 10% is accepted as good. We had 9.2%. The use of CSF drainage in these patients, as well as the use of left bypass and moderate hypothermia in the Crawford types I, II and III appear to be acceptable for prophylaxis of paraplegia. (C) 2012 Sociedad Espanola de Anestesiologia, Reanimacion y Terapeutica del Dolor. Published by Elsevier Espana, S.L. All rights reserved.