Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Aichi, Japan.
Department of Cardiovascular Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonen-cho, Nakagawa-ku, Nagoya, 454-0854, Aichi, Japan.
Surg Today. 2020 Feb;50(2):106-113. doi: 10.1007/s00595-019-01853-2. Epub 2019 Jul 22.
Postoperative spinal cord injury is a devastating complication after aortic arch replacement. The purpose of this study was to determine the predictors of this complication.
A group of 254 consecutive patients undergoing aortic arch replacement via median sternotomy, with (n = 78) or without (n = 176) extended replacement of the upper descending aorta, were included in a risk analysis. The frozen elephant trunk technique was used in 46 patients. The patients' atherothrombotic lesions (extensive intimal thickening of > 4 mm) were identified from computed tomography images.
Complete paraplegia (n = 7) and incomplete paraparesis (n = 4) occurred immediately after the operation (permanent spinal cord injury rate, 1.97%; transient spinal cord injury rate, 2.36%). A multivariable logistic regression analysis identified the use of the frozen elephant trunk technique (odds ratio 36.3), previous repair of thoracoabdominal aorta or descending aorta (odds ratio 29.4), proximal atherothrombotic aorta (odds ratio 9.6), chronic obstructive lung disease (odds ratio 7.1) and old age (odds ratio 1.1) as predictors of spinal cord injury (p < 0.0001, area under curve 0.93).
Spinal cord injury occurs with a non-negligible incidence following aortic arch replacement. The full objective assessment of the morphology of the whole aorta and the recognition of the risk factors are mandatory.
主动脉弓置换术后脊髓损伤是一种毁灭性的并发症。本研究旨在确定该并发症的预测因素。
对 254 例经正中胸骨切开术行主动脉弓置换术的患者进行了风险分析，其中包括（n=78）或不包括（n=176）上降主动脉的扩展置换。46 例患者采用冷冻象鼻技术。从 CT 图像中识别出患者的动脉粥样硬化血栓病变（>4mm 的广泛内膜增厚）。
术后即刻发生完全性截瘫（n=7）和不完全性截瘫（n=4）（永久性脊髓损伤发生率 1.97%；暂时性脊髓损伤发生率 2.36%）。多变量逻辑回归分析确定了使用冷冻象鼻技术（优势比 36.3）、胸主动脉或降主动脉的先前修复（优势比 29.4）、近端动脉粥样硬化主动脉（优势比 9.6）、慢性阻塞性肺疾病（优势比 7.1）和高龄（优势比 1.1）是脊髓损伤的预测因素（p<0.0001，曲线下面积 0.93）。
主动脉弓置换术后脊髓损伤的发生率不可忽视。必须对整个主动脉的形态进行全面客观评估，并识别出危险因素。
