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Ann Thorac Surg 1999;67:1038-1043
© 1999 The Society of Thoracic Surgeons
a Department of Cardiovascular Surgery, University of Milan, Milan, Italy
b Centro Cardiologico "I Monzino" Foundation - IRCCS, Milan, Italy
Accepted for publication September 28, 1998.
Address reprint requests to Dr Porqueddu, Department of Cardiovascular Surgery, "I Monzino" Foundation IRCCS, Via Parea 4, 20138 Milan, Italy
e-mail: porqueddum{at}lycosmail.com
Background. Although significant advances have been made in the surgical treatment of diseases affecting the descending thoracic aorta, paraplegia remains a devastating complication. We propose the quick, simple clamping technique to prevent spinal cord ischemic injury.
Methods. From 1983 to 1998, 143 patients had descending thoracic aorta aneurysm repair. We divided the patients into the following three groups according to the surgical technique used: selective atriodistal bypass was used in group 1 (66 patients); simple clamping technique in group 2 (28 patients); and quick simple clamping technique in group 3 (49 patients). Mean aortic cross clamp time was 39 ± 13 minutes in group 1, 37 ± 11 minutes in group 2, and 17 ± 6 minutes in group 3 (p < 0.01 group 3 versus group 1 and group 2).
Results. The overall incidence of paraplegia was 4.8% (7 patients), 4.5% (3 patients) in group 1, 14.3% (4 patients) in group 2, and 0 in group 3 (p < 0.05 group 3 versus group 2). The overall in-hospital mortality rate was 5.5%. Multivariate logistic regression analysis showed a powerful effect of aortic cross-clamping time as risk factor for both paraplegia (p < 0.008), with an odds ratio of 1.03 per minute, and in-hospital mortality (p < 0.001), with an odds ratio of 2.5 per minute. The mean follow-up time was 65 months with a lower overall mortality rate in group 3 than in group 1 and group 2 (p < 0.05).
Conclusion. In descending thoracic aortic aneurysm repair, spinal cord perfusion can be maintained adequately without reimplantation of segmental vessels or use of atriodistal bypass when the aortic cross-clamp time is short (< 15 to 20 minutes).
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