Spinal cord injury following aortic arch replacement

被引：8

作者：

Tokuda, Yoshiyuki ^{[1
]}

Fujimoto, Kazuro ^{[1
]}

Narita, Yuji ^{[1
]}

Mutsuga, Masato ^{[1
]}

Terazawa, Sachie ^{[1
]}

Ito, Hideki ^{[1
]}

Matsumura, Yasumoto ^{[1
]}

Uchida, Wataru ^{[1
]}

Munakata, Hisaaki ^{[1
]}

Ashida, Shinichi ^{[1
]}

Ono, Tsukasa ^{[1
]}

Nishi, Toshihiko ^{[1
]}

Yano, Daisuke ^{[1
]}

Ishida, Shinichi ^{[1
]}

Kuwabara, Fumiaki ^{[2
]}

Akita, Toshiaki ^{[1
]}

Usui, Akihiko ^{[1
]}

机构：

[1] Nagoya Univ, Dept Cardiac Surg, Grad Sch Med, Showa Ku, 65 Tsurumai, Nagoya, Aichi 4668550, Japan

[2] Nagoya Ekisaikai Hosp, Dept Cardiovasc Surg, Nakagawa Ku, 4-66 Shonen Cho, Nagoya, Aichi 4540854, Japan

来源：

SURGERY TODAY | 2020年 / 50卷 / 02期

关键词：

Aortic arch replacement; Paraplegia; Spinal cord injury; SELECTIVE CEREBRAL PERFUSION; BODY CIRCULATORY ARREST; ELEPHANT TRUNK; ISCHEMIA; REPAIR; ANEURYSMS; OUTCOMES; SURGERY; RISK; PARAPLEGIA;

D O I：

10.1007/s00595-019-01853-2

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Purpose Postoperative spinal cord injury is a devastating complication after aortic arch replacement. The purpose of this study was to determine the predictors of this complication. Methods A group of 254 consecutive patients undergoing aortic arch replacement via median sternotomy, with (n = 78) or without (n = 176) extended replacement of the upper descending aorta, were included in a risk analysis. The frozen elephant trunk technique was used in 46 patients. The patients' atherothrombotic lesions (extensive intimal thickening of > 4 mm) were identified from computed tomography images. Results Complete paraplegia (n = 7) and incomplete paraparesis (n = 4) occurred immediately after the operation (permanent spinal cord injury rate, 1.97%; transient spinal cord injury rate, 2.36%). A multivariable logistic regression analysis identified the use of the frozen elephant trunk technique (odds ratio 36.3), previous repair of thoracoabdominal aorta or descending aorta (odds ratio 29.4), proximal atherothrombotic aorta (odds ratio 9.6), chronic obstructive lung disease (odds ratio 7.1) and old age (odds ratio 1.1) as predictors of spinal cord injury (p < 0.0001, area under curve 0.93). Conclusions Spinal cord injury occurs with a non-negligible incidence following aortic arch replacement. The full objective assessment of the morphology of the whole aorta and the recognition of the risk factors are mandatory.

引用

页码：106 / 113

页数：8

共 29 条

[1] Mortality and paraplegia after thoracoabdominal aortic aneurysm repair:: A risk factor analysis [J].