BACKGROUND: In previous studies of the neurologic outcome of patients undergoing thoracoabdominal aortic aneurysm repair with the simple cross-clamp technique, cross-clamp time of greater than 30 minutes was identified as an important risk factor. We retrospectively examined the effect of clamp time of 30 minutes or greater on outcome for patients undergoing repair with the addition of surgical adjuncts. METHODS: Between February 1991 and June 1996 we operated on 370 patients for thoracoabdominal or descending thoracic aortic aneurysm. Two hundred seventy-one of these patients with cross-clamp times of 30 minutes or greater were included in this study. One hundred twelve patients underwent simple cross-clamp repair, whereas 159 were operated on with the surgical adjuncts of distal aortic perfusion and cerebrospinal fluid drainage. RESULTS: By multivariate analysis, acute dissection, surgical adjuncts, and aneurysm extent proved most significant in overall patient outcome. The overall rate of early neurologic deficits was 23 of 271 (8.5%). For highest risk patients with type II thoracoabdominal aortic aneurysms, the rate of neurologic deficits was 11 of 29 (38%) for cross-clamp versus 6 of 82 (7.3%) for adjunct operation patients (odds ratio = 0.13; p < 0.001). CONCLUSIONS: The adjuncts of cerebrospinal fluid drainage and distal aortic perfusion decreased the risk of extended cross-clamp time during thoracoabdominal aortic aneurysm repair, particularly for highest risk type II.
BACKGROUND: In previous studies of the neurologic outcome of patients undergoing thoracoabdominal aortic aneurysm repair with the simple cross-clamp technique, cross-clamp time of greater than 30 minutes was identified as an important risk factor. We retrospectively examined the effect of clamp time of 30 minutes or greater on outcome for patients undergoing repair with the addition of surgical adjuncts. METHODS: Between February 1991 and June 1996 we operated on 370 patients for thoracoabdominal or descending thoracic aortic aneurysm. Two hundred seventy-one of these patients with cross-clamp times of 30 minutes or greater were included in this study. One hundred twelve patients underwent simple cross-clamp repair, whereas 159 were operated on with the surgical adjuncts of distal aortic perfusion and cerebrospinal fluid drainage. RESULTS: By multivariate analysis, acute dissection, surgical adjuncts, and aneurysm extent proved most significant in overall patient outcome. The overall rate of early neurologic deficits was 23 of 271 (8.5%). For highest risk patients with type II thoracoabdominal aortic aneurysms, the rate of neurologic deficits was 11 of 29 (38%) for cross-clamp versus 6 of 82 (7.3%) for adjunct operation patients (odds ratio = 0.13; p < 0.001). CONCLUSIONS: The adjuncts of cerebrospinal fluid drainage and distal aortic perfusion decreased the risk of extended cross-clamp time during thoracoabdominal aortic aneurysm repair, particularly for highest risk type II.
Authors: Dimitra Papanikolaou; Chris Savio; Mohammad A Zafar; Leon Freudzon; Jinlin Wu; Mohamed Abdelbaky; Keith J Pelletier; Joelle Buntin; Thais Faggion Vinholo; Bulat A Ziganshin; Brian Schwartz; John A Elefteriades Journal: Int J Angiol Date: 2019-12-09
Authors: Daniela Lobenwein; Rosalie Huber; Lars Kerbler; Alexandra Gratl; Sabine Wipper; Can Gollmann-Tepeköylü; Johannes Holfeld Journal: J Clin Med Date: 2022-04-11 Impact factor: 4.964
Authors: Blake Shultz; Tomasz Timek; Alan T Davis; John Heiser; Edward Murphy; Charles Willekes; Robert Hooker Journal: J Cardiothorac Surg Date: 2016-07-12 Impact factor: 1.637
Authors: Bruce R Boti; Vikash G Hindori; Emilio L Schade; Athina M Kougioumtzoglou; Eva C Verbeek; Annet Driessen-Waaijer; Riccardo Cocchieri; Bas A J M de Mol; Nils R Planken; Abdullah Kaya; Henk A Marquering Journal: J Cardiothorac Surg Date: 2019-10-12 Impact factor: 1.637