Journal of Shandong University (Health Sciences) ›› 2024, Vol. 62 ›› Issue (9): 80-85.doi: 10.6040/j.issn.1671-7554.0.2024.0313

• Advances in Basic and Clinical Research on Aortic Diseases-Clinical Research • Previous Articles    

Spinal cord protection by normothermic auto-arterial bypass and distal-anastomosis-first strategy in thoracoabdominal aortic replacement surgery

SUN Jing1, ZHANG Shuai1, QI Hongxia2, LI Yuan1, ZHOU Yongkang1, HU Kejian3, QIAN Xiangyang1   

  1. 1. Department of Cardiovascular Surgery;
    2. Ultrasound Division;
    3. Department of Nursing, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
  • Published:2024-10-10

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Abstract: Objective To summarize the application of the normothermic artery bypass and visceral-anastomosis-first strategy in thoracoabdominal aortic aneurysm(TAAA)repair and to evaluate its spinal cord protective effect, so as to accumulate clinical experience for the implementation of this procedure in thoracoabdominal aortic replacement surgery. Methods We retrospectively analyzed data of patients who underwent thoracoabdominal aortic replacements with normothermic artery bypass and visceral-anastomosis-first strategy at Fuwai Hospital, Chinese Academy of Medical Sciences, between June 2019 and June 2022. Relevant clinical data(baseline data, perioperative indices, and follow-up outcome indices)were collected to assess the overall treatment outcome, as well as the safety and efficacy of the strategy. Results A total of 27 patients with TAAA were treated surgically for TAAA repair using the normothermic autoarterial diversion with a visceral priority strategy. Among them, 2 cases(7.4%)were Crawford classification typeⅠ, 14 cases(51.9%)were type Ⅱ, 9 cases(33.3%)were type Ⅲ, and 2 cases(7.4%)were type Ⅳ. The mean/median time for surgery, postoperative mechanical ventilation, postoperative ICU time, and postoperative hospital stay were(562.5±99.5)min,(30.8±25.3)h, 112.00(69.00, 162.00)min, and(19.8±8.4)d, respectively. One case(3.7%)died within 30 days of surgery, and the remaining patients survived. Acute renal failure was observed in 3 cases(11.1%)and re-thoracotomy due to hemorrhage was performed in 1 case(3.7%). Except for the deceased patient, the remaining 26 patients were followed up for a period from 6 to 56 months with a mean follow-up of(34.0±11.5)months. There were no paraplegia, deaths or other surgical complications during the follow-up period. Conclusion The normothermic artery bypass and visceral-anastomosis-first strategy can be safely and effectively used to treat TAAA and may reduce the incidence of spinal cord injury complications.

Key words: Thoracoabdominal aortic aneurysm, Thoracoabdominal aortic replacement, Spinal cord injury, Paraplegia, Visceral protection

CLC Number: 

  • R543.1
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