Spinal cord complications after thoracic aortic surgery: Long-term survival and functional status varies with deficit severity
Spinal cord complications after thoracic aortic surgery: Long-term survival and functional status varies with deficit severity
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DOI：
10.1016/j.jvs.2008.02.047
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发表时间：
2008-07-01
影响因子：
4.3
通讯作者：
Cambria, Richard P.
中科院分区：
文献类型：
--
作者：
Conrad, Mark F.;Ye, Jason Y.;Cambria, Richard P.
目的：胸腹部动脉瘤（TAA）修复后截瘫与生存率低相关。关于脊髓缺血性（SCI）并发症的严重程度谱的信息很少。本研究根据损伤严重程度对SCI进行分层，以确定其对晚期生存率和功能结局的影响。回顾了1987年5月至2005年12月前瞻性维护的胸主动脉数据库，以识别TAA修复后发生任何程度SCI的患者。在此期间，576例患者接受了胸降主动脉修复术（93例开放手术，105例血管内[TEVAR]）或开放性TAA修复术（279例I至III级; 99例IV级）。为了对SCI的严重程度进行分层，我们创建了脊髓缺血缺陷（SCID）量表，其定义为：I，弛缓性麻痹; II，平均神经肌肉等级，表明50%的功能。通过精算方法对这些组的长期结局进行评估。在研究期间，64例（11.1%）患者发生任何严重程度的SCI（7/105 [6.6%] TEVAR，57/471 [12%]开放性）。这些患者按SCID水平分层：I级，24例（37.5%）; II级，31例（48.4%）; III级，9例（14.1%）。脊髓损伤即刻33例（54.1%），延迟28例（45.9%）。与TEVAR相关的大多数SCI（7例中的6例）延迟。SCI组的30天死亡率明显高于整个患者队列（64例患者中有15例[23.4%] vs 512例患者中有41例[8%]，P <0.001），并且根据SCID级别而变化：I，II 24例（45.8%）; II，31例中有4例（12.9%）; III，9例中有0例（0%; P = 0.001）。所有SCI患者的5年生存率均低于非SCI患者（25%+/-6% vs 51%+/-3%，P <0.001），并随SCID水平线性变化，但SCID II/III和非SCI患者之间相似（41%+/-10% vs 51%+/-3%，P = 0.281）。5年时无SCID I患者存活。没有患者与SCID我恢复行走的能力，但8个11（73%）与SCID II和9（100%）与SCID III可以走动或没有援助在最后follow.Conclusion：生存和功能的结果与SCI的严重程度。SCID I患者的长期前景不佳。SCID II/III患者的生存率与非SCI患者相似;大多数患者恢复了行走能力。
Objective: Paraplegia after thoracoabdominal aneurysm (TAA) repair has been associated with poor survival. Little information exists concerning the spectrum of severity that characterizes spinal cord ischemic (SCI) complications. This study stratified SCI by deficit severity to determine its impact on late survival and functional outcomes.Methods. A review of our prospectively maintained thoracic aortic database was performed from May 1987 through December 2005 to identify patients who experienced SCI of any extent after TAA repair. During this period, 576 patients underwent descending thoracic aortic repair (93 open, 105 endovascular [TEVAR]) or open TAA repair (279 extent I to III; 99 extent IV). To stratify severity of SCI, we created a spinal cord ischemia deficit (SCID) scale, which is defined as: I, flaccid paralysis; II, average neurologic muscle grade indicating 50% function. Long-term outcomes were evaluated in relation to these groups by actuarial methods.Results. During the study period, 64 (11.1%) patients developed SCI of any severity (7 of 105 [6.6%] TEVAR, 57 of 471 [12%] open). These were stratified by SCID level: I, 24 (37.5%); II, 31 (48.4%); and III, 9 (14.1%). SCI was immediate in 33 (54.1%) and delayed in 28 (45.9%). Most SCI (6 of 7) associated with TEVAR was delayed. The 30-day mortality was significantly higher in the SCI group than the overall patient cohort (15 of 64 [23.4%] vs 41 of 512 [8%], P < .001) and varied by SCID level: I, II of 24 (45.8%); II, 4 of 31 (12.9%); and III, 0 of 9 (0%; P = .001). The 5-year actuarial survival for all SCI was lower than for non-SCI patients (25% +/- 6% vs 51% +/- 3%, P < .001) and varied linearly with SCID level but was similar between SCID II/III and the non-SCI patients (41% +/- 10% vs 51% +/- 3%, P = .281). No SCID I patients were alive at 5 years. No patients with SCID I recovered the ability to walk, but eight of 11 (73%) with SCID II and the nine (100%) with SCID III could ambulate with or without assistance at last follow-up.Conclusion: Survival and functional outcomes correlate with SCI severity. Patients with SCID I have a poor long-term outlook. Survival of SCID II/III patients is similar to non-SCI patients; most recover the ability to ambulate.