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Ann Thorac Surg 2007;83:1345-1355
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Delayed Spinal Cord Deficits After Thoracoabdominal Aortic Aneurysm Repair

^a Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas
^b Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas

Accepted for publication November 9, 2006.

^_* Address correspondence to Dr LeMaire, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX 77030 (Email: slemaire{at}bcm.edu).

Presented at the Fifty-second Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 10–12, 2005.

Background: Limited information is available about the treatment and outcomes of delayed paraplegia after thoracoabdominal aortic aneurysm (TAAA) repair. The objective of this study was to assess factors that precipitate and favorably affect delayed-onset neurologic deficits.

Methods: Over a 19-year period, 2,368 TAAA repairs were performed. Of the 93 patients (3.9%) who had postoperative paraplegia or paraparesis, 34 (37%) initially had intact neurologic function, but a delayed spinal cord deficit developed. We retrospectively examined clinical factors and events associated with development of the deficits, treatments used, and outcomes. Factors related to functional status were evaluated by comparing survivors who were ambulatory at discharge or transfer with those who were not.

Results: The delayed deficits occurred between 13 hours and 91 days postoperatively and were associated with a period of hypotension in 9 patients (26%). Two patients (6%) died in hospital. Of the 32 patients discharged or transferred, 13 (41%) were ambulatory. Poor functional outcomes were associated with female sex, intraoperative cerebrospinal fluid drainage, fewer intercostal arteries reattached, and administration of corticosteroids or osmotic diuretics. The actuarial survival rate at 2 years was 80% ± 13% for the ambulatory patients and 32% ± 12% for the nonambulatory patients (p = 0.002).

Conclusions: Although precipitating episodes of hypoperfusion were common, most cases of delayed paraplegia occurred without such events, suggesting that other factors may play an important role in the development of this complication. Ambulatory status at discharge significantly predicts midterm survival.

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