Impact of Intercostal Artery Reinsertion on Neurological Outcome after Thoracoabdominal Aortic Replacement: A 25-Year Single-Center Experience
Background: Intercostal artery reinsertion (ICAR) during thoracoabdominal aortic replacement remains controversial. While some groups recommend the reinsertion of as many arteries as possible, others consider the sacrifice of multiple intercostals practicable. This study investigates the impact of i...
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| Format: | Article |
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MDPI AG
2024-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/3/832 |
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| author | Florian Helms Reza Poyanmehr Heike Krüger Bastian Schmack Alexander Weymann Aron-Frederik Popov Arjang Ruhparwar Andreas Martens Ruslan Natanov |
| author_facet | Florian Helms Reza Poyanmehr Heike Krüger Bastian Schmack Alexander Weymann Aron-Frederik Popov Arjang Ruhparwar Andreas Martens Ruslan Natanov |
| author_sort | Florian Helms |
| collection | DOAJ |
| description | Background: Intercostal artery reinsertion (ICAR) during thoracoabdominal aortic replacement remains controversial. While some groups recommend the reinsertion of as many arteries as possible, others consider the sacrifice of multiple intercostals practicable. This study investigates the impact of intercostal artery reinsertion or sacrifice on neurological outcomes and long-term survival after thoracoabdominal aortic repair. Methods: A total of 349 consecutive patients undergoing thoracoabdominal aortic replacement at our institution between 1996 and 2021 were analyzed in a retrospective single-center study. ICAR was performed in 213 patients, while all intercostal arteries were ligated and sacrificed in the remaining cases. The neurological outcome was analyzed regarding temporary and permanent paraplegia or paraparesis. Results: No statistically significant differences were observed between the ICAR and non ICAR groups regarding the cumulative endpoint of transient and permanent spinal cord-related complications (12.2% vs. 11.8%, <i>p</i> = 0.9). Operation, bypass, and cross-clamp times were significantly longer in the ICAR group. Likewise, prolonged mechanical ventilation was more often necessary in the ICAR group (26.4% vs. 16.9%, <i>p</i> = 0.03). Overall long-term survival was similar in both groups in the Kaplan–Meier analysis. Conclusion: Omitting ICAR during thoracoabdominal aortic replacement may reduce operation and cross-clamp times and thus minimize the duration of intraoperative spinal cord hypoperfusion. |
| first_indexed | 2024-03-08T03:54:13Z |
| format | Article |
| id | doaj.art-f8645173f0214d4ebc342e54cc166233 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-08T03:54:13Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-f8645173f0214d4ebc342e54cc1662332024-02-09T15:16:18ZengMDPI AGJournal of Clinical Medicine2077-03832024-01-0113383210.3390/jcm13030832Impact of Intercostal Artery Reinsertion on Neurological Outcome after Thoracoabdominal Aortic Replacement: A 25-Year Single-Center ExperienceFlorian Helms0Reza Poyanmehr1Heike Krüger2Bastian Schmack3Alexander Weymann4Aron-Frederik Popov5Arjang Ruhparwar6Andreas Martens7Ruslan Natanov8Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanyDivision for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanyDivision for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanyDivision for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanyDivision for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanyDivision for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanyDivision for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanyClinic for Cardiac Surgery, University Clinic Oldenburg, 26133 Oldenburg, GermanyClinic for Cardiac Surgery, University Clinic Oldenburg, 26133 Oldenburg, GermanyBackground: Intercostal artery reinsertion (ICAR) during thoracoabdominal aortic replacement remains controversial. While some groups recommend the reinsertion of as many arteries as possible, others consider the sacrifice of multiple intercostals practicable. This study investigates the impact of intercostal artery reinsertion or sacrifice on neurological outcomes and long-term survival after thoracoabdominal aortic repair. Methods: A total of 349 consecutive patients undergoing thoracoabdominal aortic replacement at our institution between 1996 and 2021 were analyzed in a retrospective single-center study. ICAR was performed in 213 patients, while all intercostal arteries were ligated and sacrificed in the remaining cases. The neurological outcome was analyzed regarding temporary and permanent paraplegia or paraparesis. Results: No statistically significant differences were observed between the ICAR and non ICAR groups regarding the cumulative endpoint of transient and permanent spinal cord-related complications (12.2% vs. 11.8%, <i>p</i> = 0.9). Operation, bypass, and cross-clamp times were significantly longer in the ICAR group. Likewise, prolonged mechanical ventilation was more often necessary in the ICAR group (26.4% vs. 16.9%, <i>p</i> = 0.03). Overall long-term survival was similar in both groups in the Kaplan–Meier analysis. Conclusion: Omitting ICAR during thoracoabdominal aortic replacement may reduce operation and cross-clamp times and thus minimize the duration of intraoperative spinal cord hypoperfusion.https://www.mdpi.com/2077-0383/13/3/832aortic surgerythoracoabdominal aortaintercostal artery reinsertionspinal cord protection |
| spellingShingle | Florian Helms Reza Poyanmehr Heike Krüger Bastian Schmack Alexander Weymann Aron-Frederik Popov Arjang Ruhparwar Andreas Martens Ruslan Natanov Impact of Intercostal Artery Reinsertion on Neurological Outcome after Thoracoabdominal Aortic Replacement: A 25-Year Single-Center Experience Journal of Clinical Medicine aortic surgery thoracoabdominal aorta intercostal artery reinsertion spinal cord protection |
| title | Impact of Intercostal Artery Reinsertion on Neurological Outcome after Thoracoabdominal Aortic Replacement: A 25-Year Single-Center Experience |
| title_full | Impact of Intercostal Artery Reinsertion on Neurological Outcome after Thoracoabdominal Aortic Replacement: A 25-Year Single-Center Experience |
| title_fullStr | Impact of Intercostal Artery Reinsertion on Neurological Outcome after Thoracoabdominal Aortic Replacement: A 25-Year Single-Center Experience |
| title_full_unstemmed | Impact of Intercostal Artery Reinsertion on Neurological Outcome after Thoracoabdominal Aortic Replacement: A 25-Year Single-Center Experience |
| title_short | Impact of Intercostal Artery Reinsertion on Neurological Outcome after Thoracoabdominal Aortic Replacement: A 25-Year Single-Center Experience |
| title_sort | impact of intercostal artery reinsertion on neurological outcome after thoracoabdominal aortic replacement a 25 year single center experience |
| topic | aortic surgery thoracoabdominal aorta intercostal artery reinsertion spinal cord protection |
| url | https://www.mdpi.com/2077-0383/13/3/832 |
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