Cerebrospinal fluid drainage and distal aortic perfusion: Reducing neurologic complications in repair of thoracoabdominal aortic aneurysm types I and II

Purpose: This study was conducted to evaluate the role of cerebrospinal fluid (CSP) drainage and distal aortic perfusion (DAP) in the prevention of postoperative neurologic complications for high-risk patients who had undergone type I and type II thoracoabdominal aortic aneurysm (TAAA) repair. Methods: CSP drainage and DAP were used as an adjunct in the treatment of 94 patients with TAAA(31 type I, 63 type II) between September 1992 and December 1994; 67 were men and 27 were women. The median age was 64 years (range, 28 to 88 years). Aortic dissection occurred in 35 of 94 patients (37%). Thirty-six of 94 patients (38%) had previously undergone proximal aortic surgery. All patients underwent intraoperative DAP and perioperative CSP drainage. Median aortic cross-clamp time was 67 minutes (race, 20 to 131 minutes). Results: The 30-day survival rate was 90% (85 of 94 patients). Early neurologic complications occurred in 5 of 94 patients (5%), and late neurologic complications occurred in 3 of 94 patients (3%). We compared the neurologic complications of our current group of 94 patients with the data from 42 patients (control group) who also underwent repair of TAAA type I and type II with only simple cross-clamp and without CSP drainage or DAP. Both groups were treated by the senior author (HJS) at the same institution. Total neurologic complications for the current group occurred in 8 of 94 patients (9%) versus 8 of 42 patients (19%) for the control group (p = 0.090). Neurologic complications for patients with type II TAAA occurred in 8 of 63 patients (13%) versus 17 of 42 patients (41%) (p = 0.014). For all patients with aortic clamp times greater than or equal to 45 minutes, neurologic complications occurred in 7 of 55 (13%) versus 7 of 18 (39%) (p = 0.033). Conclusion: The period of risk during aortic cross-clamp time is reduced with the adjuncts of CSP drainage and DAP, which significantly lower the incidence of neurologic complications after repair of TAAA types I and II.