Predicting the Risk of Paraplegia After Thoracic and Thoracoabdominal Aneurysm Repair Stefano Zoli, MD, Fabian Roder, MS, Christian D. Etz, MD, PhD,

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Presentation transcript:

Predicting the Risk of Paraplegia After Thoracic and Thoracoabdominal Aneurysm Repair Stefano Zoli, MD, Fabian Roder, MS, Christian D. Etz, MD, PhD, Robert M. Brenner, MS, Carol A. Bodian, DrPH, Hung-Mo Lin, DrPH, Gabriele Di Luozzo, MD, Randall B. Griepp, MD The Annals of Thoracic Surgery Volume 90, Issue 4, Pages 1237-1245 (October 2010) DOI: 10.1016/j.athoracsur.2010.04.091 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Number of segmental artery (SA) pairs sacrificed during thoracic or thoracoabdominal aortic aneurysm repair at each location, with the corresponding paraplegia rate. The extent of resection is disregarded. If sacrifice of a single segmental artery had been critical, a spike in spinal cord injury (SCI) rate at that level would have been anticipated. The Annals of Thoracic Surgery 2010 90, 1237-1245DOI: (10.1016/j.athoracsur.2010.04.091) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Distribution of different perfusion techniques used for each Mount Sinai group (defined in detail in the text). (A) 100% stacked column. (B) Absolute number histogram. (CPBP = cardiopulmonary bypass; HCA = hypothermic circulatory arrest; LHBP = partial distal aortic perfusion with left heart bypass.) The Annals of Thoracic Surgery 2010 90, 1237-1245DOI: (10.1016/j.athoracsur.2010.04.091) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Distribution of spinal cord ischemic events (n = 21) based on the extent and location of aortic resection. The x axis represents the proximal origin of resection, and the z axis shows the extent. The inset figure shows the expected paraplegia rates with 95% confidence interval based on the proposed four-group classification. (CI = confidence interval; SA = segmental artery.) The Annals of Thoracic Surgery 2010 90, 1237-1245DOI: (10.1016/j.athoracsur.2010.04.091) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Aneurysm extent and location in each of the 609 patients based on segmental artery sacrifice, grouped according to the Mount Sinai classification system and the proximal origin of resection. The Annals of Thoracic Surgery 2010 90, 1237-1245DOI: (10.1016/j.athoracsur.2010.04.091) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Comparison between era 1 (striped bars) and era 2 (black bars) patients (before and after introduction of routine motor-evoked potential monitoring) with respect to extent of aneurysms, categorized according to the Mount Sinai classification for assessing paraplegia risk. The Annals of Thoracic Surgery 2010 90, 1237-1245DOI: (10.1016/j.athoracsur.2010.04.091) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions