ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Kenji Okada
Yutaka Okita
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kawanishi, Y.
Right arrow Articles by Okita, Y.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kawanishi, Y.
Right arrow Articles by Okita, Y.
Related Collections
Right arrow Great vessels

Ann Thorac Surg 2007;84:488-492
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Influence of Perioperative Hemodynamics on Spinal Cord Ischemia in Thoracoabdominal Aortic Repair

Yujiro Kawanishi, MD, Kenji Okada, MD, Masamichi Matsumori, MD, Hiroshi Tanaka, MD, Teruo Yamashita, MD, Keitaro Nakagiri, MD, Yutaka Okita, MD*

Department of Cardiovascular, Thoracic, and Pediatric Surgery, Kobe University Graduate School of Medicine, Kobe City, Hyogo, Japan

Accepted for publication February 28, 2007.

* Address correspondence to Dr Okita, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan (Email: yokita{at}med.kobe-u.ac.jp).

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.

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.

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.

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.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2007 by The Society of Thoracic Surgeons.