Thoracic and thoracoabdominal aortic repair under regional spinal cord hypothermia

Abstract

Objectives: Spinal cord deficits are devastating complications after surgery for thoracic and thoracoabdominal aortic aneurysms. We developed a regional spinal cord cooling system using an epidural catheter containing cold saline within an isolated counter-current lumen to prevent such complications and reviewed the clinical results.

Methods: We enrolled 37 patients with thoracic (n = 13) and thoracoabdominal (n = 24) aortic aneurysms that were repaired using the regional spinal cord cooling system under mild hypothermia with a partial femoro-femoral bypass.

Results: Although 2 patients died before hospital discharge (hospital mortality, 5.4%), none developed neurological deficits such as paraplegia or paraparesis.

Conclusions: The outcomes of surgery for thoracic and thoracoabdominal aortic aneurysms under regional spinal cord hypothermia using a custom-designed epidural catheter were excellent. Although our patient cohort was small, the results indicate that our technique might help to improve the outcomes of thoracic and thoracoabdominal aortic repair.

Keywords: Aneurysm; Aortic operation; Cardiopulmonary bypass; Surgery techniques.