The Impact of Preoperative Identification of the Adamkiewicz Artery on Spinal Cord Protection in Descending and Thoracoabdominal Aortic Repair: A Japanese.

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Presentation transcript:

The Impact of Preoperative Identification of the Adamkiewicz Artery on Spinal Cord Protection in Descending and Thoracoabdominal Aortic Repair: A Japanese Multicenter Study Hiroshi Tanaka 1, Hitoshi Ogino 2, 1, Kenji Minatoya 1, Yoshiro Matsui 3, Tetsuya Higami 4, Hitoshi Okabayashi 5, Yoshikatsu Saiki 6, Shigeyuki Aomi 7, Norihiko Shiiya 8, Yoshiki Sawa 9, Takahiro Katsumata 14, Yutaka Okita 10, Taijiro Sueda 11, Shigeaki Aoyagi 12, Yukio Kuniyoshi 13, Hitoshi Matsuda 1, Hiroaki Sasaki 1, Yutaka Iba 1 1. Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan. 2. Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan. 3. Department of Cardiovascular Surgery, Hokkaido University, Sapporo, Japan. 4. Second Department of Surgery, Supporo Medical University, Sapporo, Japan. 5. Department of Cardiovascular Surgery, Iwate Medical University, Morioka, Japan. 6. Department of Cardiovascular Surgery, Tohoku Univerisity, Sendai, Japan. 7. Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan. 8. First Department of Surgery, Hamamatsu Medical University, Hamamatsu, Japan. 9. Department of Cardiovascular Surgery, Osaka University, Osaka, Japan. 10. Department of Cardiovascular Surgery, Kobe University, Kobe, Japan. 11. First Department of Surgery, Hiroshima University, Hiroshima, Japan. 12. Department of Surgery, Kurume University, Kurume, Japan. 13. Second Department of Surgery, Ryukyu University, Naha, Japan. 14. Department of Thoracic and Cardiovascular Surgery, Osaka Medical University, Osaka, Japan.

No disclosure

Objectives To investigate whether preoperative identification of the Adamkiewicz artery could be an adjunct to reduce the incidence of spinal cord injury in descending and thoracoabdominal aortic repair.

Patients and Methods Multicenter study - 12 Japanese cardiovascular centers January 2000 – December ,435 descending and thoracoabdominal aortic repairs 1,471 open repairs, 964 endovascular repairs Preoperative AKA examNo AKA examTotal Open repair878 (60%)593 (40%)1,471 Endovascular repair374 (39%)590 (61%)964

Detect of the Adamkiewicz Artery (AKA)

Distribution of the location of the AKA Right Left Identified in 1,096 / 1,252 (87.6%)

Patients Profile – Open repair (n=1471) n% Age (y)64±13 Male Gender Hypertension Hyperlipidemia Diabetus Smoking Coronary artery disease Renal failure Dialysis513.4 Cerebrovascular disease Chronic lung disease Liver disease80.5 Aortic pathology Dissection Non - dissection infection793.2 Emergent AKA identification Operative procedures

ExtentMortality (%)Spinal cord injury (%) I II III IV V Descending Total Risk factors for spinal cord injury (multivariate analysis) OR95% CIp Male gender Age > 65 yo Chronic lung disease Renal failure Extent I, II, III < Emergent AKA identification

Open repair : 1471 SCI (7.3%) Identified AKA : 748 (7.8) No AKA exam : 593 (6.9) No definite AKA identified : 128 (6.3) Operation involving AKA: 454 (8.6)Operation not involving AKA : 244 (7.4) AKA preserved or reconstructed : 349 AKA ligated : 51Occluded AKA : 54

Multivariate analysis of risk factors for SCI in open repairs involving AKA OR95% CIp Male gender – Age > 65 yo – Chronic lung disease Renal failure – Extent I, II, III – Emergent – AKA ligation –

Endovascular repair : 964 SCI (2.9%) Identified AKA : 344 (3.5) No AKA exam : 590 (2.5) No definite AKA identified : 30 (3.3) Operation involving AKA: 62 (3.2)Operation not involving AKA : 282 (3.5) No significant risk factors for SCI Endovascular Repair (n=964) Hospital mortality 62 / 964 (6.4%)

Conclusions In open descending and thoracoabdominal aortic repair involving the origin of the AKA, preoperative identification of the AKA and its following intraoperative reconstruction could be an adjunct for spinal cord protection.