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Japanese perspective in surgery for thoracoabdominal aortic aneurysms
Norihiko Shiiya1, Naoki Washiyama2, Kazumasa Tsuda2
1First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan. shiyanor@hama-med.ac.jp.
General Thoracic and Cardiovascular Surgery
|September 22, 2017
Summary
Thoracoabdominal aortic surgery outcomes improved with a strategy focusing on spinal cord protection. Selective intercostal reconstruction, guided by artery mapping, reduced complications and maintained graft patency, showing promising results for complex aortic repairs.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Surgery
Background:
- Thoracoabdominal aortic surgery carries high operative mortality and morbidity risks.
- Spinal cord protection remains a critical challenge in these complex procedures.
Purpose of the Study:
- To report the strategy and outcomes of thoracoabdominal aortic replacement, with a specific focus on spinal cord protection.
- To evaluate the effectiveness of selective intercostal reconstruction guided by preoperative feeding artery localization.
Main Methods:
- Retrospective analysis of 178 patients undergoing thoracoabdominal aortic replacement.
- Utilized distal aortic perfusion, multi-segmental sequential repair, and selective intercostal reconstruction guided by preoperative feeding artery localization.
- Deep hypothermic circulatory arrest was reserved for specific cases requiring open aortic anastomosis.
Main Results:
- Achieved a low hospital mortality rate of 3.9% and a spinal cord injury rate of 5.1%.
- Preoperative feeding artery localization led to reduced reconstruction needs and improved graft patency (92% patency for grafts connected to feeding arteries).
- Redo operations demonstrated outcomes comparable to de novo operations, with no associated mortality or spinal cord injury.
Conclusions:
- The strategy of selective intercostal reconstruction, aimed at maximizing spinal cord collateral blood flow, appears effective for spinal cord protection.
- This approach offers a justified method for improving outcomes in thoracoabdominal aortic surgery.