Spinal cord protection by normothermic artery bypass and visceral-anastomosis-first strategy in thoracoabdominal aortic aneurysm repair

This study addresses spinal cord injury, a severe complication of thoracoabdominal aortic aneurysm (TAAA) surgery. It introduces and assesses a new surgical strategy—normothermic artery bypass and visceral-anastomosis-first—aimed at reducing this risk by prioritizing blood supply to vital organs and the spinal cord during the repair process. The new surgical strategy involves first reconstructing visceral and distal vessels while maintaining blood supply to the spinal cord through intercostal arteries. This is followed by reconstructing the intercostal arteries and completing the proximal anastomosis, ensuring the spinal cord receives the longest possible duration of physiological blood supply. The study compared this new strategy to normothermic iliac artery perfusion, focusing on early postoperative complications and the protective effects on visceral organs, particularly the spinal cord. The results indicated a significantly lower incidence of paraplegia and reduced need for postoperative mechanical ventilation with the new approach.

• 1
  The incidence of paraplegia was significantly lower in the NABP group (0.00%) compared to the NIP group (9.72%), with a p-value of 0.047.
• 2
  The duration of postoperative mechanical ventilation was significantly lower in the NABP group compared to the NIP group (p = 0.004).
• 3
  The incidence of gastrointestinal adverse events was significantly lower in the NABP group (7.32%) compared to the NIP group (45.83%), with a p-value less than 0.001.