Back to Search
Start Over
Influence of perioperative hemodynamics on spinal cord ischemia in thoracoabdominal aortic repair.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2007 Aug; Vol. 84 (2), pp. 488-92. - Publication Year :
- 2007
-
Abstract
- Background: The purpose of this study is to investigate the influence of perioperative circulation on spinal cord during the repair of descending thoracic or thoracoabdominal aortic aneurysms.<br />Methods: From October 1999, 92 patients (aged 66 +/- 13 years; 65 men) underwent the repair of descending thoracic (n = 30) or thoracoabdominal aortic aneurysm (Crawford I, 9; II, 14; III, 35; IV, 4). We measured the time duration of hypotension, defined as follows, and evaluated the relationship between the incidence of paraplegia and each duration: T1, systolic arterial pressure less than 80 mm Hg, or mean pressure less than 60 mm Hg during aortic cross-clamping; T2, distal aortic pressure less than 60 mm Hg during aortic cross-clamping; T3, systolic arterial pressure less than 80 mm Hg after coming off bypass; T4, systolic arterial pressure less than 80 mm Hg in the intensive care unit.<br />Results: Hospital mortality was 8% (7 patients). Neurologic deficits occurred in 10 patients (10.9%). The T1 and T2 periods showed no difference between paraplegia cases (group P) and normal cases (group N). The T3 periods in both groups were 54 +/- 52 and 6.6 +/- 18, and the T4 periods were 62 +/- 89 and 2.3 +/- 14, respectively. The T3 and T4 periods in group P were significantly longer than in group N (p < 0.0001). Multivariate analysis demonstrated that T3 was an independent risk factor for paraplegia. When divided according to body temperature, the T2 period under mild hypothermia was significantly longer in group P than in group N, as well as the T3 and T4 periods.<br />Conclusions: Perioperative hemodynamics stability is of vital importance for spinal cord protection during thoracoabdominal aortic surgery. In particular, the duration of hypotension after coming off bypass was an independent risk factor for paraplegia.
- Subjects :
- Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal classification
Aortic Aneurysm, Abdominal mortality
Aortic Aneurysm, Thoracic classification
Aortic Aneurysm, Thoracic mortality
Blood Pressure
Cardiac Surgical Procedures methods
Comorbidity
Female
Hospital Mortality
Humans
Hypotension epidemiology
Hypothermia epidemiology
Male
Monitoring, Intraoperative
Paraplegia epidemiology
Retrospective Studies
Systole
Aortic Aneurysm, Abdominal surgery
Aortic Aneurysm, Thoracic surgery
Blood Circulation physiology
Ischemia physiopathology
Perioperative Care
Spinal Cord blood supply
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 84
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 17643620
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2007.02.089