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Related Experiment Videos

Risk of spinal cord dysfunction in patients undergoing thoracoabdominal aortic replacement.

L H Hollier1, S R Money, T C Naslund

  • 1Department of Surgery, Alton Ochsner Medical Foundation, New Orleans, Louisiana.

American Journal of Surgery
|September 11, 1992
PubMed
Summary

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A new perioperative protocol significantly reduced spinal cord dysfunction after thoracoabdominal aortic replacement. This multimodality approach, implemented since 1989, proved effective without increasing operative mortality.

Area of Science:

  • Cardiovascular Surgery
  • Neurosurgery
  • Vascular Surgery

Background:

  • Thoracoabdominal aortic replacement is a complex procedure with a significant risk of spinal cord dysfunction.
  • Previous approaches lacked a standardized protocol to mitigate neurological complications.

Purpose of the Study:

  • To evaluate the effectiveness of a prospective, multimodality perioperative protocol in reducing spinal cord dysfunction following thoracoabdominal aortic replacement.
  • To compare neurological outcomes between patients treated with and without the protocol.

Main Methods:

  • Retrospective review of 150 patients undergoing thoracoabdominal aortic replacement (1980-1991).
  • Implementation of a multimodality protocol since June 1989, including intercostal reimplantation, cerebrospinal fluid drainage, hypertension, hypothermia, barbiturates, mannitol, steroids, and calcium channel blockers.

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  • Neurological function and operative mortality were assessed.

    • Main Results:

    • Spinal cord dysfunction decreased from 6% (6/108) in the pre-protocol group to 0% (0/42) in the protocol group (p<0.01).
    • Overall 30-day operative mortality showed no significant difference between groups (9% vs. 12%, p=NS).
    • 97% of patients survived for neurological evaluation.

    Conclusions:

    • A multimodality perioperative protocol is effective in significantly reducing the incidence of spinal cord dysfunction after thoracoabdominal aortic replacement.
    • The protocol can be implemented without adversely affecting operative mortality rates.
    • This strategy represents a valuable advancement in patient safety for complex aortic surgery.