Boston - American Association for Thoracic Surgery

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS12. Staged Repair Significantly Reduces Paraplegia Rate AfterExtensive Thoracoabdominal Aortic Aneurysm RepairChristian D. Etz, Stefano Zoli, Christoph S. Mueller, Carol A. Bodian,Gabriele Di Luozzo, Ricardo Lazalla, Konstadinos A. Plestis, Randall B. Griepp *Mount Sinai School of Medicine, New York, NY, USAInvited Discussant: Joseph S. CoselliOBJECTIVE: Paraplegia remains a devastating—and still too frequent—complicationafter repair of extensive thoracoabdominal aortic aneurysms (TAAA). Strategiesto prevent ischemic spinal cord damage following extensive segmental artery(SA) sacrifice—or occlusion, essential for endovascular repair—are still evolving.METHODS: 90 patients (pts) who underwent extensive SA sacrifice (median:13,range: 9–15; see figure) during open surgical repair from 06/94–12/07 werereviewed retrospectively. 55 pts—most with extensive TAAA/Crawford type II;mean age 65 ± 12 yrs; 49% male—had a single procedure (1-stage group). 35 ptshad two operations (2-stage-group): usually Crawford type III or IV repair afteroperation for descending thoracic aneurysm (DTA)/Crawford type I; mean age:62 ± 14 yrs; 57% male. The median interval between the 2-stage procedures was5 yrs (3 months–17 yrs). There were no significant differences between the groupswith regard to age, gender, etiology of the aneurysm, hypertension, COPD, urgency,previous cerebrovascular accidents, year of procedure, or CSF drainage. In 1-stageprocedures, hypothermic circulatory arrest (HCA) was used in 29%; left heartbypass in 40%, and distal aortic perfusion in 27%. Somato-sensory evoked potentials(SSEP) were monitored in all pts, and motor-evoked potentials in 39%. CSF wasdrained in 84%.* AATS Member90