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General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 4/2020

01-04-2020 | Aortic Dissection | Original Article

Risk factors for spinal cord injury in patients undergoing frozen elephant trunk technique for acute aortic dissection

Authors: Daijiro Hori, Sho Kusadokoro, Koichi Adachi, Naoyuki Kimura, Koichi Yuri, Harunobu Matsumoto, Atsushi Yamaguchi

Published in: General Thoracic and Cardiovascular Surgery | Issue 4/2020

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Abstract

Background

The purpose of this study was to evaluate the risk factors for spinal cord injury (SCI) in patients with acute aortic dissection undergoing surgery with frozen elephant trunk technique (FET).

Methods

From December 2014 to February 2018, 17 patients with acute aortic dissection underwent surgical treatment of the aortic arch with FET. SCI occurred in 3 patients. Risk factors for SCI were evaluated.

Results

Mean age of the patients was 56 years and 88.2% were male. The ratio of true lumen to total aortic diameter at the level of carina (before: 0.48 vs. after: 0.75, P < 0.001), aortic valve (before: 0.47 vs. after: 0.67, P = 0.001), and celiac artery (before: 0.48 vs. after: 0.68, P = 0.003) increased after surgery. There were no significant differences in perioperative minimum hemoglobin level and postoperative mean arterial pressure between patients with and without SCI. However, patients with SCI had higher creatinine level before surgery (SCI: 1.32 mg/dL vs. no SCI: 0.81 mg/dL, P = 0.023). Although there was no difference in number of patent intercostal arteries before surgery, those originating from the true lumen were fewer in patients with SCI (SCI: 2.7 vs. no SCI: 8.6, P = 0.021). Furthermore, with entry closure, significant decrease in patency was observed in intercostal arteries originating from the false lumen (before: 3.1 vs. after: 1.0, P < 0.001).

Conclusion

FET was useful in entry closure. However, FET in patients with higher creatinine level and those who may have significant spinal cord perfusion from the false lumen could be a risk factor for postoperative SCI.
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Metadata
Title
Risk factors for spinal cord injury in patients undergoing frozen elephant trunk technique for acute aortic dissection
Authors
Daijiro Hori
Sho Kusadokoro
Koichi Adachi
Naoyuki Kimura
Koichi Yuri
Harunobu Matsumoto
Atsushi Yamaguchi
Publication date
01-04-2020
Publisher
Springer Singapore
Published in
General Thoracic and Cardiovascular Surgery / Issue 4/2020
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-019-01196-2

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