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Surgery of the descending thoracic aorta: spinal cord protection with the Gott shunt
A Verdant1, A Pagé, R Cossette
1Division of Cardiovascular and Thoracic Surgery, Hôpital du Sacré-Coeur de Montréal, Université de Montré, Que, Canada.
Insights
This study demonstrates the effectiveness of the 9-mm Gott shunt in preventing spinal cord injury during descending thoracic aortic aneurysm surgery. The technique achieved a 0% rate of paraplegia in 168 patients evaluated.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Descending thoracic aortic aneurysms pose significant surgical risks, including spinal cord ischemia.
- Effective distal perfusion strategies are crucial for minimizing complications during aortic cross-clamping.
Purpose of the Study:
- To evaluate the efficacy of a specific external shunting technique for distal perfusion during surgical repair of descending thoracic aortic aneurysms.
- To assess the incidence of spinal cord ischemic injury in patients undergoing this procedure.
Main Methods:
- A retrospective review of 173 patients treated between 1974 and 1987.
- Utilized a single external shunting method (9-mm Gott aneurysm shunt) for distal perfusion without systemic heparinization.
- Varied cannulation sites based on aneurysm location and extent.
Main Results:
- Hospital mortality was 15% (26/173), including ruptured aneurysms.
- No cases of paraplegia or spinal cord ischemic injury were observed in 168 patients evaluated for neurological function.
- Mean aortic cross-clamp time was 37 minutes.
Conclusions:
- The 9-mm Gott shunt is an effective method for maintaining spinal cord perfusion during descending thoracic aortic aneurysm surgery.
- This technique significantly reduces the risk of devastating neurological complications such as paraplegia.
Abstract:
From July, 1974, to July, 1987, surgical treatment of descending thoracic aortic aneurysms was performed in 173 patients at l'Hôpital du Sacré-Coeur de Montréal. The cause of the aneurysms was arteriosclerosis or medial degeneration in 83 patients, trauma in 50, dissection in 34, and a congenital malformation in 6. A single method of external shunting provided distal perfusion in all patients in the series. A 9-mm Gott aneurysm shunt was placed preferentially between the ascending aorta (67%) and the descending aorta (60%). Alternative sites of proximal cannulation (aortic arch, 9%; proximal descending aorta, 22%; left ventricle, 2%) and distal cannulation (abdominal aorta, 3%; left femoral artery, 37%) were chosen based on the location and the extent of the aortic aneurysm. No systemic heparinization was used. In the last 40 patients, a flowmeter adapted for use with the shunt allowed the recording of shunt flow (mean, 2,475 ml/min; range, 1,100 to 4,000 ml/min). Hospital mortality, including patients with ruptured aneurysms, was 15% (26/173). The mean aortic cross-clamp time was 37 minutes (range, 8 to 105 minutes). Of the 173 patients, 168 survived long enough to allow accurate clinical evaluation of the function of the spinal cord: no paraplegia or other spinal cord ischemic injury occurred. To date, our clinical experience has demonstrated the effectiveness of the 9-mm Gott shunt in preserving the functional integrity of the spinal cord during cross-clamping of the thoracic aorta.