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Improved outcome in thoracoabdominal aortic aneurysm repair

The role of cerebrospinal fluid drainage

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Abstract

Introduction: To evaluate the protective effect and the optimum duration of cerebrospinal fluid drainage (CSFD) during and after thoracoabdominal aortic aneurysm (TAAA) repair.

Methods: From April 2001 to October 2003, we retrospectively compared 17 (n=17) consecutive patients who have been electively operated on by Martin Grabenwoger for left heart bypass and selective perfusion of the visceral and renal organs.

Results: The first 7 patients had CSFD for 72 hours; the duration of CSFD was increased to 100 hours in the remaining 10 patients. Median drained cerebrospinal fluid (CSF) volume was 680 milliliters in the 72-hour group versus 1441 milliliters in the 100-hour group. A characteristic increase in CSF volume was noted between POD No. 2 and POD No. 4 indicating persistent spinal cord edema. Univariate and multivariate analysis demonstrated that CSFD for 100 hours is a significant predictor for decreased incidence of late onset paraplegia (p<0.001). The overall incidence of postoperative neurological deficit was 17.6% (3 of 17). There was one patient (6%) who developed permanent paraplegia and two patients (12%) with transient paraplegia. These patients sustained late-onset paraplegia 72 hours after surgery for removal of a CSFD device. Complete motor function could be restored after re-insertion of a CSFD device. In one patient, permanent paraplegia was evident after awakening from anesthesia. Because of technical difficulties, only two intercostal arteries could be re-implanted, which was obviously not sufficient to restore spinal cord perfusion. In contrast, no neurological deficit occurred in patients in whom a CSFD instrument was left for 100 hours.

Conclusion: The extended duration of CSFD may lower the risk of late-onset paraplegia and could improve outcome in patients undergoing thoracoabdominal aortic surgery.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria

    Tatjana M. Fleck MD, Reinhard Moidl, Martin Czerny, Carole Hamilton, Ernst Wolner & Martin Grabenwoger

  2. Department of Cardiothoracic and Vascular Anaesthesia, University of Vienna, Vienna, Austria

    Herbert Koinig, Arno Schifferer & Marian Jelen

Authors
  1. Tatjana M. Fleck MD
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  2. Herbert Koinig
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  3. Reinhard Moidl
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  4. Martin Czerny
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  5. Carole Hamilton
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  6. Arno Schifferer
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  7. Marian Jelen
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  8. Ernst Wolner
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  9. Martin Grabenwoger
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Correspondence to Tatjana M. Fleck MD.

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Fleck, T.M., Koinig, H., Moidl, R. et al. Improved outcome in thoracoabdominal aortic aneurysm repair. Neurocrit Care 2, 11–16 (2005). https://doi.org/10.1385/NCC:2:1:011

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