Simultaneous Carotid Endarterectomy and Coronary Artery Bypass Grafting Is Associated With Similar Clinical Outcomes With Lower Length of Stay and Hospital Charges

Abstract

We analyzed all TEVARs from 2005 to 2014 using a prospectively maintained, institutional review board-approved database to study all transient and permanent paraparesis and paralysis. TEVARs for trauma were excluded. Arch debranching was performed before TEVAR in patients with arch involvement. All patients had hypothermia (34 Centigrade), mean arterial pressure (MAP) >90 mm Hg, hemoglobin (Hb) >10 mg/ dL, mannitol 12.5 g, methylprednisolone 30 mg/kg, and naloxone 1 mcg/kg/hr for spinal cord protection. Patients where >12 cm of aortic coverage was planned had spinal fluid drainage (SFD) to <8 mm Hg pressure during surgery and postoperatively until normal leg strength was confirmed. We studied demographics, intraoperative variables, SCI, and calculated observed/expected ratio (O/E) for SCI. Results: A total of 155 patients had TEVAR from 2005 to 2014. Median age was 74 years (range, 21-88 years). Fifty-six percent were male, 91% (141/155) had TAA, and 9% (14/155) had TAAA. Twenty-six percent (40/155) had dissection. Forty-two percent (65/155) were acute. Nineteen percent (29/155) had arch debranching, and 72% (111/155) had SFD. Mean aortic coverage was 22 cm (range, 3.5-50 cm). Eighty-one percent (125/155) had >12 cm thoracic aortic coverage, and 48% (75/ 155) had complete coverage from subclavian to celiac artery. Hospital mortality was 2% (3/155). One percent (2/155) had stroke. One patient had delayed transient paraparesis (0.64% SCI). O/E ratio for SCI was 0.029. Conclusions: SCI in TEVAR can be prevented by using intraoperative neuroprotective interventions to prolong spinal cord ischemic tolerance and increase spinal cord perfusion and oxygen delivery.