초록접수 현황
| 14F-092 | 구연 발표 |
Delayed Spinal Cord Ischemia - Still Unresolved Problem with Contemporary Strategy of Thoracoabdominal Aortic Surgery
Yoon Cheol Shin, Dong Jung Kim, Suryeun Chung, Jun Sung Kim, Cheong Lim, Kay-Hyun Park.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine
Background : This study aimed to investigate the features of spinal cord ischemia(SCI), a serious complication developed by the surgical repair of thoracoabdominal aorta, with a strategy adopting contemporary concept of collateral network.
Methods : Retrospective review was performed for the medical records of 135 patients (mean age 55.6±16.5 years) who underwent surgical replacement of thoracoabdominal aorta (type I 28.1%, II 43.0%, III 20.7%, IV 8.1%) from May 2006 through July 2014. Surgical strategy included the use of extracorporeal circulation(92.6%) for distal aortic perfusion but avoiding hypothermic arrest (only in 4.4%), CSF drainage (74.8%), mild hypothermia (32-33℃), segmental clamping, and maintenance of hypertension (systolic≥120mmHg) after aortic clamping. Limited number of intercostal arteries between T7 and T12 were selectively reimplanted.
Results : In-hospital mortality rate was 7.4% and SCI occurred in 12 patients (9.0%). Except for 1 patient who showed immediate paraparesis and completely recovered, all other SCI events occurred at various intervals after surgery (6 hours~28 days). Four patients (3.3%) became permanently paraplegic and the others walked out of the hospital. All permanent SCI events were explained by problems, such as respiratory distress or low cardiac output, which could not be promptly corrected by our management protocol; elevation of blood pressure (systolic≥140mmHg), resumption of CSF drainage, mannitol, and steroid therapy.
Conclusion : Our strategy adopting physiologic concept of spinal cord perfusion is considered effective for preventing intraoperative injury. However, the potential risk of delayed SCI caused by cord devascularization necessitates careful attention.
Methods : Retrospective review was performed for the medical records of 135 patients (mean age 55.6±16.5 years) who underwent surgical replacement of thoracoabdominal aorta (type I 28.1%, II 43.0%, III 20.7%, IV 8.1%) from May 2006 through July 2014. Surgical strategy included the use of extracorporeal circulation(92.6%) for distal aortic perfusion but avoiding hypothermic arrest (only in 4.4%), CSF drainage (74.8%), mild hypothermia (32-33℃), segmental clamping, and maintenance of hypertension (systolic≥120mmHg) after aortic clamping. Limited number of intercostal arteries between T7 and T12 were selectively reimplanted.
Results : In-hospital mortality rate was 7.4% and SCI occurred in 12 patients (9.0%). Except for 1 patient who showed immediate paraparesis and completely recovered, all other SCI events occurred at various intervals after surgery (6 hours~28 days). Four patients (3.3%) became permanently paraplegic and the others walked out of the hospital. All permanent SCI events were explained by problems, such as respiratory distress or low cardiac output, which could not be promptly corrected by our management protocol; elevation of blood pressure (systolic≥140mmHg), resumption of CSF drainage, mannitol, and steroid therapy.
Conclusion : Our strategy adopting physiologic concept of spinal cord perfusion is considered effective for preventing intraoperative injury. However, the potential risk of delayed SCI caused by cord devascularization necessitates careful attention.
책임저자: Kay-Hyun Park
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine
연락처 : Yoon Cheol Shin, Tel: 031-787-7140 , E-mail : cheolkweon@hanmail.net
