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Cardiac function is a risk factor for paralysis in thoracoabdominal aortic replacement

C W Acher1, M M Wynn, J R Hoch

  • 1Department of Surgery, University of Wisconsin-Madison, 53792-7375, USA.

Journal of Vascular Surgery
|June 10, 1998
PubMed
Summary

Cerebrospinal fluid drainage (CSFD) and naloxone significantly reduce paralysis risk in thoracoabdominal aortic replacement. A decrease in cardiac index during aortic occlusion is a key risk factor for paralysis.

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Area of Science:

  • Cardiovascular Surgery
  • Neurosurgery
  • Vascular Surgery

Background:

  • Thoracoabdominal aortic replacement is a complex procedure with significant risks.
  • Paralysis, renal dysfunction, and mortality are major concerns following this surgery.

Purpose of the Study:

  • To investigate factors influencing paralysis risk, renal function, and mortality in patients undergoing thoracoabdominal aortic replacement.
  • To evaluate the efficacy of cerebrospinal fluid drainage (CSFD) and low-dose naloxone in reducing paralysis risk.

Main Methods:

  • Prospective data collection of preoperative and intraoperative factors in 217 patients.
  • Univariate and multivariate analyses to identify risk factors for paralysis, renal function, and mortality.
  • Comparison of outcomes between patients receiving CSFD and naloxone (Group A) and those who did not (Group B).

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Main Results:

  • Group A (CSFD and naloxone) had significantly lower paralysis rates (5/147) compared to Group B (12/58).
  • Multivariate analysis identified acute presentation, Crawford type 2 aneurysm, Group B membership, and decreased cardiac index as significant risk factors for paralysis.
  • Preoperative creatinine levels predicted renal function, while renal revascularization improved it. Mortality was higher in acute presentations.

Conclusions:

  • CSFD and low-dose naloxone are effective in reducing paralysis risk during thoracoabdominal aortic replacement.
  • A decrease in cardiac index with aortic occlusion is a novel predictor of increased paralysis risk.
  • Acute presentation, age, and preoperative creatinine levels are significant predictors of operative mortality.