Helms Florian, Poyanmehr Reza, Krüger Heike, Schmack Bastian, Weymann Alexander, Popov Aron-Frederik, Ruhparwar Arjang, Martens Andreas, Natanov Ruslan
Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
Clinic for Cardiac Surgery, University Clinic Oldenburg, 26133 Oldenburg, Germany.
J Clin Med. 2024 Jan 31;13(3):832. doi: 10.3390/jcm13030832.
Intercostal artery reinsertion (ICAR) during thoracoabdominal aortic replacement remains controversial. While some groups recommend the reinsertion of as many arteries as possible, others consider the sacrifice of multiple intercostals practicable. This study investigates the impact of intercostal artery reinsertion or sacrifice on neurological outcomes and long-term survival after thoracoabdominal aortic repair.
A total of 349 consecutive patients undergoing thoracoabdominal aortic replacement at our institution between 1996 and 2021 were analyzed in a retrospective single-center study. ICAR was performed in 213 patients, while all intercostal arteries were ligated and sacrificed in the remaining cases. The neurological outcome was analyzed regarding temporary and permanent paraplegia or paraparesis.
No statistically significant differences were observed between the ICAR and non ICAR groups regarding the cumulative endpoint of transient and permanent spinal cord-related complications (12.2% vs. 11.8%, = 0.9). Operation, bypass, and cross-clamp times were significantly longer in the ICAR group. Likewise, prolonged mechanical ventilation was more often necessary in the ICAR group (26.4% vs. 16.9%, = 0.03). Overall long-term survival was similar in both groups in the Kaplan-Meier analysis.
Omitting ICAR during thoracoabdominal aortic replacement may reduce operation and cross-clamp times and thus minimize the duration of intraoperative spinal cord hypoperfusion.
胸腹主动脉置换术中肋间动脉再植术（ICAR）仍存在争议。一些团队建议尽可能多地再植动脉，而另一些团队则认为牺牲多条肋间动脉是可行的。本研究调查了肋间动脉再植或牺牲对胸腹主动脉修复术后神经功能结局和长期生存的影响。
在一项回顾性单中心研究中，分析了1996年至2021年间在本机构连续接受胸腹主动脉置换术的349例患者。213例患者进行了ICAR，其余病例中所有肋间动脉均被结扎并牺牲。分析了关于暂时性和永久性截瘫或轻瘫的神经功能结局。
在短暂性和永久性脊髓相关并发症的累积终点方面，ICAR组和非ICAR组之间未观察到统计学上的显著差异（12.2%对11.8%，P = 0.9）。ICAR组的手术、体外循环和阻断时间明显更长。同样，ICAR组更常需要延长机械通气时间（26.4%对16.9%，P = 0.03）。在Kaplan-Meier分析中，两组的总体长期生存率相似。
在胸腹主动脉置换术中省略ICAR可能会减少手术和阻断时间，从而将术中脊髓低灌注的持续时间降至最低。
