Tanaka Akiko, Sandhu Harleen K, Nguyen Hung, Mills Alexander, Kiser Kelsie, Afifi Rana O, Zhou Shao Feng, Miller Charles C, Safi Hazim J, Estrera Anthony L
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex.
Department of Anesthesiology, McGovern Medical School at UTHealth Houston, Houston, Tex.
JTCVS Tech. 2024 Aug 5;27:9-18. doi: 10.1016/j.xjtc.2024.07.018. eCollection 2024 Oct.
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).
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.
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.
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.
在开放性降胸段和胸腹主动脉瘤（DTAA/TAAA）修复术中，2004年7月至2009年6月我们采用常规的T8 - T12肋间动脉（ICA）重新附着策略，2009年7月至2016年以及2017年后，我们采用选择性ICA重新附着策略（仅在神经监测信号消失时重新附着T8 - T12 ICA）。本研究回顾了我们近20年的经验，以评估两种ICA重新附着策略对脊髓损伤（SCI）的影响。
纳入2004年7月至2022年6月期间进行的所有开放性DTAA/TAAA修复术病例，但不包括术中未行脑脊液引流的病例。回顾围手术期数据。采用单变量和多变量分析以及倾向匹配法，对两种ICA重新附着策略对SCI的风险调整效应进行分析。
总共375例患者采用选择性策略进行手术，584例采用常规策略。两组患者的年龄、破裂率和再次手术率相似。手术死亡率和即刻SCI发生率也相似（选择性策略组与常规策略组：死亡率，12.5%对12.3%；即刻SCI，3.2%对2.2%）。然而，选择性策略组延迟性和永久性SCI的发生率增加（延迟性，10.4%对6.9%；永久性，8.5%对5.3%）。多变量分析表明，选择性策略是延迟性和永久性SCI的预测因素，同时还有TAAA范围II/III和年龄较大。
两种ICA重新附着策略对不常见的即刻SCI发生率没有影响，但选择性策略与更高的延迟性永久性SCI发生率相关。在开放性DTAA/TAAA手术期间，应进行T8 - T12范围内ICA的重新附着。
