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Spinal cord injury following aortic arch replacement

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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

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Acknowledgements

The authors thank Yuko Sugiura, the institutional surgical data manager, for her contribution to managing the databases in a precise manner.

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Authors and Affiliations

  1. Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Aichi, Japan

    Yoshiyuki Tokuda, Kazuro Fujimoto, Yuji Narita, Masato Mutsuga, Sachie Terazawa, Hideki Ito, Yasumoto Matsumura, Wataru Uchida, Hisaaki Munakata, Shinichi Ashida, Tsukasa Ono, Toshihiko Nishi, Daisuke Yano, Shinichi Ishida, Toshiaki Akita & Akihiko Usui

  2. Department of Cardiovascular Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonen-cho, Nakagawa-ku, Nagoya, 454-0854, Aichi, Japan

    Fumiaki Kuwabara

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  1. Yoshiyuki Tokuda
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Correspondence to Yoshiyuki Tokuda.

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Tokuda, Y., Fujimoto, K., Narita, Y. et al. Spinal cord injury following aortic arch replacement. Surg Today 50, 106–113 (2020). https://doi.org/10.1007/s00595-019-01853-2

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  • DOI: https://doi.org/10.1007/s00595-019-01853-2

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