Paraplegia following surgery of the descending thoracic aorta

Paraplegia remains an uncontrollable complication of aortic reconstructive surgery. Twenty-one consecutive patients undergoing surgery at the Royal Adelaide Hospital for lesions of the descending thoracic aorta were reviewed. Those patients suffering an acute traumatic transection had a much higher rate of postoperative paraplegia (40%) than those undergoing elective reconstruction of chronic aneurysms (10%). The incidence of paraplegia after surgery for an acute transection when bypass was not employed was greater than 50%. In contrast, the outcome was successful in all patients who underwent reconstruction using left heart extracorporeal bypass. Based on these findings, the routine use of bypass during reconstruction of the thoracic aorta is recommended, particularly for acute traumatic transection.