Introduction of adjuncts and their influence on changing results in 402 consecutive thoracoabdominal aortic aneurysm repairs☆

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Abstract
Objective: To assess the influence of adjuncts, cerebrospinal fluid drainage (CSFD) and evoked potentials, on morbidity and mortality after thoracoabdominal aortic aneurysm (TAAA) repair and to update our experience. Methods: Between February 1981 and February 2003, 402 consecutive patients underwent repair of their TAAA using simple cross-clamping between 1981 and 1994 (n=123; CC), left heart bypass (from 1987; n=254) or extracorporeal circulation (n=25; ADJ). Somatosensory evoked potentials were used in 264 patients and motor evoked potentials in 176 patients. CSFD was used in 202 patients (50.2%). Results: Overall hospital mortality was 10.9:14.1% in the CC-group versus 9.1% in the ADJ-group (P=0.07). The incidence of postoperative dialysis was 6.1%. Paraplegia and paraparesis together was found in 11.3%. Independent risk factors for hospital mortality were age (OR 1.1 per year, 95% CI 1.04–1.16), rupture (OR 3.8, 95% CI 1.7–8.8) and postoperative hemodialysis (OR 8.1, 95% CI 3.2–20.3). For postoperative hemodialysis the risk factors were age≥75 years (OR 3.2, 95% CI 1.1–9.7), a preoperative creatinine level higher than 150 μM/l (OR 6.5, 95% CI 2.6–16.2), and as a protective factor operation performed after 1995 (OR 0.2, 95% CI 0.06–0.6). For spinal cord dysfunction (paraplegia and paraparesis together) the protective factors were age≥75 years (OR 0.16, 95% CI 0.02–1.2), operation performed after 1995 (OR 0.31, 95% CI 0.15–0.65) and a previous aortic dissection (OR 0.38, 95% CI 0.15–0.9). Conclusions: The use of different adjuncts introduced over the years clearly influenced our results in a positive way.

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