Thoracoabdominal Aneurysm Repair: Spinal Cord Protection Using Profound Hypothermia and Circulatory Arrest

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Abstract
Between January 1991 and February 1993,14 patients (11 male, 3 female) between 21 and 79 years of age (median 50 years) underwent reconstruction of the thoracic (n = 7) and thoracoabdominal aorta (n = 7). Four patients had previously undergone operation of the ascending aorta, and In three patients coronary artery bypass grafting had previously been performed. All patients were operated on via a posterolateral thoracotomy using cardiopulmonary bypass wlth continuous blood cardloplegla and hypothermlc circulatory arrest (11 °C naso-pharyngeal temperature, flat-EEG). All patent lower intercostal and lumbar arteries (T3 to L5) were reimplanted. The 30-day mortality after repair of the thoracic aorta was 0%; after replacement of the thoracoabdomlnal aorta, mortality was 28.5% (n = 2). One patient died 70 days after replacement of the thoracic aorta as a consequence of a perioperative stroke. None of the surviving 11 patients developed a permanent neurological deficit or renal or cardiac dysfunction. The average Intensive care stay was 6 days for patients after replacement of the thoracic aorta and 18 days for patients after replacement of the thoracoabdominal aorta. Our results suggest that use of elective hypothermia and circulatory arrest for spinal cord protection is highly effective. We, therefore, recommend this method for complex reconstructions of the thoracoabdominal aorta. (J Card Surg 1994;9:679–684)