Hazim J. Safi, MD, Anthony L. Estrera, MD, Charles C

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Presentation transcript:

Evolution of Risk for Neurologic Deficit After Descending and Thoracoabdominal Aortic Repair Hazim J. Safi, MD, Anthony L. Estrera, MD, Charles C. Miller, PhD, Tam T. Huynh, MD, Eyal E. Porat, MD, Ali Azizzadeh, MD, Riad Meada, MD, Jennifer S. Goodrick, RN The Annals of Thoracic Surgery Volume 80, Issue 6, Pages 2173-2179 (December 2005) DOI: 10.1016/j.athoracsur.2005.05.060 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Classification of thoracoabdominal aortic aneurysms. Extent I, distal to the left subclavian artery to above the renal arteries. Extent II, distal to the left subclavian artery to below the renal arteries; this is the most extensive type of aneurysm and the only extent that is still associated with risk of paraplegia, with the use of adjunct distal aortic perfusion, cerebrospinal fluid, and moderate hypothermia. Extent III, from the sixth intercostal space to below the renal arteries. Extent IV, from the twelfth intercostal space to the iliac bifurcation (total abdominal aortic aneurysm). Extent V, below the sixth intercostal space to just above the renal arteries. The Annals of Thoracic Surgery 2005 80, 2173-2179DOI: (10.1016/j.athoracsur.2005.05.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Percent adjunct use by aneurysm extent per quartile. (DTAA = descending thoracic aortic aneurysm.) The Annals of Thoracic Surgery 2005 80, 2173-2179DOI: (10.1016/j.athoracsur.2005.05.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Incidence (percent) of neurologic deficit (ND) for the entire cohort per quartile. (DTAA = descending thoracic aortic aneurysm.) The Annals of Thoracic Surgery 2005 80, 2173-2179DOI: (10.1016/j.athoracsur.2005.05.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Multiple logistic regression analysis according to risk of neurologic deficit (ND) and aortic cross-clamp time without adjunct use. Solid line represents extent II thoracoabdominal aortic aneurysm (TAAA), and the dashed line represents all other extents. The Annals of Thoracic Surgery 2005 80, 2173-2179DOI: (10.1016/j.athoracsur.2005.05.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Multiple logistic regression analysis according to risk of neurologic deficit (ND) and aortic cross-clamp time with adjunct use. Solid line represents extent II thoracoabdominal aortic aneurysm (TAAA), and the dashed line represents all other extents. The Annals of Thoracic Surgery 2005 80, 2173-2179DOI: (10.1016/j.athoracsur.2005.05.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Linear regression analysis of aortic cross-clamp time with regard to study year. The Annals of Thoracic Surgery 2005 80, 2173-2179DOI: (10.1016/j.athoracsur.2005.05.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions