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Ann Thorac Surg 1999;67:1931-1934
© 1999 The Society of Thoracic Surgeons

Left heart bypass reduces paraplegia rates after thoracoabdominal aortic aneurysm repair

^a Department of Surgery, Baylor College of Medicine, The Methodist Hospital, Houston, Texas, USA

Address reprint requests to Dr Coselli, Department of Surgery, Baylor College of Medicine, The Methodist Hospital, 6560 Fannin, #1100, Houston, TX 77030
e-mail: jcoselli{at}bcm.tmc.edu

Presented at the Aortic Surgery Symposium VI, April 30–May 1, 1998, New York, NY.

Background. The optimal strategy for spinal cord protection during thoracoabdominal aortic aneurysm (TAAA) repair remains unclear. We evaluated the protective effect of left heart bypass (LHB) during repair of extensive TAAAs.

Methods. During a 12-year period, 710 patients had repair of extent I or II TAAAs. Left heart bypass was used in 312 (43.9%) patients. This group was retrospectively compared with 398 (56.1%) patients who had operations without LHB.

Results. The overall 30-day survival rate was 94.8% (673 patients). In 42 patients, (6.0%) paraplegia or paraparesis developed. In patients with extent I TAAAs, paraplegia and paraparesis rates in LHB (6 of 123, 4.9%) and non-LHB (9 of 246, 3.7%) groups were similar (p = 0.576) despite longer aortic clamp times in the former group. In patients with extent II TAAAs, the LHB group had a lower incidence of paraplegia or paraparesis (9 of 189, 4.8%) compared with the non-LHB group (18 of 137, 13.1%; p = 0.007).

Conclusions. Left heart bypass reduced the risk of paraplegia and paraparesis in patients who had repair of extent I and II TAAAs.

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