Spinal cord protection during thoracoabdominal aortic replacement: spinal cord perfusion maintenance

Abstract

The present study suggests that our strategy for maintaining spinal cord perfusion pressure provides acceptable outcomes.

Open repair of thoracoabdominal aortic aneurysms in experienced centers

“…In total, 9963 patients underwent open repair for a TAAA (543 for ruptured TAAAs). [4][5][6][7][8][9][10] Baseline study characteristics of the 30 eligible studies included in the systematic review are presented in Table I Table II presents the operational techniques and types of spinal cord and visceral protection among the eligible studies. Cardiopulmonary bypass and left-sided heart bypass were the most frequently described surgical procedures in our meta-analysis.…”

“…In-hospital mortality ranged from 2.3% to 32.7%. 5,6 The total pooled mortality rate among all studies included in the meta-analysis (in-hospital, all Crawford types) was 11.26% (95% CI, 9.56-13.09; Fig 2). Mortality of open repair among all cases was 6.97% (95% CI, 3.75-10.90), 10.32% (95% CI, 7.39-13.63), 8.02% (95% CI, 6.37-9.81), and 7.20% (95% CI, 4.19-10.84) for Crawford types I, II, III, and IV, respectively (Supplementary Figs 1-4, online only).…”

“…The overall survival at 5 years of follow-up was available in 10 studies and ranged from 53.4% to 97.6%. 5,27 The pooled survival at 5 years was 69.28% (95% CI, 61.10-76.89; Supplementary Fig 6, online only).…”

“…4,6 The reintervention rate due to bleeding in the perioperative period was extracted from 14 studies and was accounted from 1.5% to 13.1%. [4][5][6][7]9,12,[15][16][17][18]22,23,26,30 Paraplegia and paraparesis rates were extracted from 23 and 14 studies, respectively. The rates ranged from 2% to 10.8% for paraplegia 14,16 and from 0% to 10% for paraparesis.…”

“…11 However, in reviewing the current outcomes of open TAAA repair between different studies in the literature, it is obvious that there is considerable variability between high-volume centers; in addition, good results have been reported from medium-and low-volume centers, reflecting the fact that the volume-outcome relationship is complex and multifactorial. 5,12 Because endovascular techniques have emerged as a demanding alternative for the treatment of TAAAs with some encouraging results, it is good timing to re-evaluate the safety of the open repair technique. We undertook a systematic review and meta-analysis with the aim of identifying all published reports on TAAA treated with open repair to assess the mortality and morbidity of this type of reconstruction.…”