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. 2024 Aug 5:27:9-18.
doi: 10.1016/j.xjtc.2024.07.018. eCollection 2024 Oct.

Routine intercostal artery reattachment strategy reduces delayed and permanent spinal cord injury after open descending thoracic and thoracoabdominal aortic aneurysm repair

Akiko Tanaka  1 , Harleen K Sandhu  1 , Hung Nguyen  1 , Alexander Mills  1 , Kelsie Kiser  1 , Rana O Afifi  1 , Shao Feng Zhou  2 , Charles C Miller 3rd  1 , Hazim J Safi  1 , Anthony L Estrera  1
Affiliations

Routine intercostal artery reattachment strategy reduces delayed and permanent spinal cord injury after open descending thoracic and thoracoabdominal aortic aneurysm repair

Akiko Tanaka et al. JTCVS Tech. .

Abstract

Objective: During open descending thoracic and thoracoabdominal aortic aneurysm (DTAA/TAAA) repair, we used a routine T8-T12 intercostal artery (ICA) reattachment strategy from July 2004 to June 2009 and after 2017, we used a selective ICA reattachment strategy (reattaching T8-T12 ICAs only when neuromonitor signals were lost) from July 2009 to 2016. This study reviewed our nearly 2-decade experience to assess the impact of 2 ICA reattachment strategies on spinal cord injury (SCI).

Methods: All open DTAA/TAAA repairs performed from July 2004 to June 2022 were included, except for cases without intraoperative cerebral spinal fluid drainage. Perioperative data were reviewed. Univariable and multivariable analyses and propensity matching for risk-adjusted effects of 2 strategies for ICA reattachment on SCI were used.

Results: In all, 375 patients were operated on with selective strategy and 584 with routine strategy. Age and prevalence of rupture and redo were similar in the 2 groups. The rate of operative mortality and immediate SCI was also similar (selective vs routine: mortality, 12.5% vs 12.3%; immediate SCI, 3.2% vs 2.2%). However, the incidence of delayed and permanent SCI was increased in the selective group (delayed, 10.4% vs 6.9%; permanent, 8.5% vs 5.3%). Multivariable analyses demonstrated selective strategy was a predictor of delayed and permanent SCI, along with TAAA extent II/III, and older age.

Conclusions: Two strategies of ICA reattachment did not impact the incidence of immediate SCI, which was infrequent, but the selective strategy was associated with greater rates of delayed permanent SCI. Reattachment of the ICAs within T8-T12 should be performed during open DTAA/TAAA.

Keywords: cerebral spinal fluid drainage; descending thoracic aortic aneurysm; intercostal reattachment; spinal cord ischemia; thoracoabdominal aortic aneurysm.

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Conflict of interest statement

Drs Estrera and Sandhu are consultants for WL Gore. Dr Estrera is a speaker for Terumo Aortic. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

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Graphical abstract
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Summary of open descending and thoracoabdominal aortic repair techniques.
Figure 1
Figure 1
Summary of open descending and thoracoabdominal aortic repair techniques. ICA, Intercostal artery; MEP, motor-evoked potentials; SSEP, somatosensory-evoked potentials; STAG, side-branched thoracoabdominal aortic graft; VP, visceral perfusion; CSFD, cerebral spinal fluid drain; DAP, distal aortic perfusion; EVAR, endovascular aortic repair.
Figure 2
Figure 2
Graphical abstract. Impact of ICA reattachment strategies on SCI after open descending and thoracoabdominal aortic aneurysm repair.
Figure E1
Figure E1
Plot of the variables for standardized mean differences included hypertension, genetic or connective tissue disorder, end-stage renal disease on dialysis, aortic dissection and peripheral arterial disease.
See this image and copyright information in PMC

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