JTCVS Open, 2023 · DOI: https://doi.org/10.1016/j.xjon.2023.05.014 · Published: September 1, 2023
This study investigates the link between spinal cord injury (SCI) after aortic dissection surgery and the blood supply to the spinal cord coming from the false lumen (FL) of the dissected aorta. The researchers looked at patients who had total arch replacement and frozen elephant trunk (FET) implantation for acute type I aortic dissection. They found that if segmental arteries (SAs) at the T9-L3 levels, which supply blood to the spinal cord, were completely dependent on the FL, the risk of SCI was significantly higher after surgery.
Surgeons should carefully assess the FL dependency of SAs at the T9-L3 levels using preoperative imaging when planning total arch replacement and FET implantation for acute DeBakey type I AAD.
Patients with FL-dependent SAs should be considered at higher risk for postoperative SCI and may benefit from modified surgical techniques or closer monitoring.
Proactive measures such as minimizing circulatory arrest time, placing a CSFD catheter, using a shorter FET, and adopting earlier anticoagulation should be considered in patients with FL-dependent SAs.