Introduction of adjuncts and their influence on changing results in 402 consecutive thoracoabdominal aortic aneurysm...

To assess the influence of adjuncts, cerebrospinal fluid drainage (CSFD) and evoked potentials, on morbidity and mortality after thoracoabdominal aortic aneurysm (TAAA) repair and to update our experience.

Between February 1981 and February 2003, 402 consecutive patients underwent repair of their TAAA using simple cross-clamping between 1981 and 1994 (n = 123; CC), left heart bypass (from 1987; n = 254) or extracorporeal circulation (n = 25; ADJ). Somatosensory evoked potentials were used in 264 patients and motor evoked potentials in 176 patients. CSFD was used in 202 patients (50.2%).

Overall hospital mortality was 10.9:14.1% in the CC-group versus 9.1% in the ADJ-group (P = 0.07). The incidence of postoperative dialysis was 6.1%. Paraplegia and paraparesis together was found in 11.3%. Independent risk factors for hospital mortality were age (OR 1.1 per year, 95% CI 1.04-1.16), rupture (OR 3.8, 95% CI 1.7-8.8) and postoperative hemodialysis (OR 8.1, 95% CI 3.2-20.3). For postoperative hemodialysis the risk factors were age >/=75 years (OR 3.2, 95% CI 1.1-9.7), a preoperative creatinine level higher than 150 microM/l (OR 6.5, 95% CI 2.6-16.2), and as a protective factor operation performed after 1995 (OR 0.2, 95% CI 0.06-0.6). For spinal cord dysfunction (paraplegia and paraparesis together) the protective factors were age >/=75 years (OR 0.16, 95% CI 0.02-1.2), operation performed after 1995 (OR 0.31, 95% CI 0.15-0.65) and a previous aortic dissection (OR 0.38, 95% CI 0.15-0.9).

The use of different adjuncts introduced over the years clearly influenced our results in a positive way.