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Joseph S. Coselli
Scott A. LeMaire
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Ann Thorac Surg 1999;67:1043-1044
© 1999 The Society of Thoracic Surgeons

Commentary

Joseph S. Coselli, MD, Scott A. LeMaire, MDa

a Department of Surgery, Baylor College of Medicine, The Methodist Hospital, 6560 Fannin, Suite 1100, Houston, TX 77030 USA

Invited commentary

Biglioli and associates reported an encouraging trend in their 16-year experience with descending thoracic aortic aneurysm repair in 143 patients. After a 10.6% incidence of paraplegia and paraparesis in the first 94 patients, there were no further neurologic deficits among the subsequent 49. Additionally, both the mean aortic cross-clamp time and in-hospital mortality rate have decreased over time. Based on these improvements, the authors propose ligating all involved intercostal arteries before simple aortic clamping as a means of preventing spinal cord injury. The authors are to be congratulated on achieving excellent results in their recent patients, but meaningful interpretation of their comparative data is difficult. In addition to the inherent limitations of retrospective comparisons using historical control groups, the study illustrates the need for standardized reporting methods in the field of thoracic aortic operations.

When comparing a recent treatment group with a historical control group, the validity of the latter must be scrutinized carefully, particularly when groups with small numbers of patients are used. The crux of the statistically significant reduction in neurologic deficits between groups 2 and 3 lies in the surprisingly high rate of paraplegia and paraparesis in group 2 (6 of 28, 21.3%). This discrepancy . . . [Full Text of this Article]


Related Article

Quick, simple clamping technique in descending thoracic aortic aneurysm repair
Paolo Biglioli, Rita Spirito, Massimo Porqueddu, Marco Agrifoglio, Giulio Pompilio, Alessandro Parolari, Luca Dainese, and Erminio Sisillo
Ann. Thorac. Surg. 1999 67: 1038-1043. [Abstract] [Full Text] [PDF]





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