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Hazim J Safi - One of the best experts on this subject based on the ideXlab platform.

  • Cerebrospinal Fluid Drainage during thoracic aortic repair safety and current management
    The Annals of Thoracic Surgery, 2009
    Co-Authors: Anthony L Estrera, Charles C Miller, Ali Azizzadeh, Roy Sheinbaum, Jon Cecil Walkes, Taek Yeon Lee, Larry R Kaiser, Hazim J Safi
    Abstract:

    Background The benefit of Cerebrospinal Fluid (CSF) Drainage during thoracic aortic repair has been established. Few studies, however, report management and safety of CSF Drainage. Methods Between September 1992 and August 2007, 1,353 repairs of the thoracic aorta were performed, with 82% using CSF Drainage. The CSF Drainage was not used in cases of rupture, acute trauma, infection, or prior paraplegia. Thirty-one percent (76 of 246) of patients without CSF Drainage were repaired prior to standardized use. All drains were inserted by cardiovascular anesthesia staff. Repairs were performed using distal aortic perfusion with heparinization. Early management involved free Drainage to maintain CSF pressure less than10 mm Hg, but was later modified to limit CSF Drainage unless neurologic deficit occurred. Results Cerebrospinal Fluid Drainage was technically achieved in 99.8% (1,105 of 1,107) of cases. The CSF catheter-related complications occurred in 1.5% (17 of 1,107) of patients. No spinal hematomas were observed. The CSF leaks with spinal headache, CSF leak without spinal headache, spinal headache, intracranial hemorrhage, catheter fracture, and meningitis occurred in 6 (0.54%), 1 (0.1%), 2 (0.2%), 5 (0.45%), 1 (0.1%), and 2 (0.2%) cases, respectively. Mortality from subdural hematoma was 40% (2 of 5), and from meningitis was 50% (1 of 2). Spinal headaches resolved with conservative management. All CSF leaks resolved, but 71% (5/7) required blood patches. Since implementation of a limited CSF Drainage protocol, no subdural hematomas have been observed. Conclusions Cerebrospinal Fluid Drainage for thoracic aortic repairs can be performed safely with excellent technical success. Perioperative management of CSF drains requires diligent monitoring and judicious Drainage. Standardizing CSF management may be beneficial.

  • descending thoracic aortic aneurysm repair 12 year experience using distal aortic perfusion and Cerebrospinal Fluid Drainage
    The Annals of Thoracic Surgery, 2005
    Co-Authors: Anthony L Estrera, Charles C Miller, Edward P Chen, Riad Meada, Ricardo H Torres, Eyal E Porat, Thi Thanh Tam Huynh, Ali Azizzadeh, Hazim J Safi
    Abstract:

    Background The benefit of distal aortic perfusion and Cerebrospinal Fluid Drainage over the "clamp and sew" technique during repairs of the descending thoracic aorta is still being debated. The purpose of this report is to analyze our experience with regard to neurologic deficit (paraplegia and paraparesis) and mortality using the adjuncts of distal aortic perfusion and Cerebrospinal Fluid Drainage. Methods Between February 1991 and September 2004, we repaired 355 descending thoracic aortic aneurysms. Excluded from analysis were 29 patients who required profound hypothermic circulatory arrest as a result of transverse arch involvement and 26 patients with aortic rupture, leaving a group of 300 patients for which outcomes were analyzed. Mean patient age was 67 years, and 102 (34%) of the patients were women. The adjunct group of distal aortic perfusion and Cerebrospinal Fluid Drainage used in 238 (79.3%) patients was compared with a group of 62 patients who underwent simple cross-clamp with or without the addition of a single adjunct. Multivariable data were analyzed by Cox regression. Results The incidence of neurologic deficit after all repairs was 2.3% (7 of 300 patients). The incidence of neurologic deficit (immediate and delayed) in the adjunct group was 1.3% (3 of 238 patients), and in the nonadjunct group was 6.5% (4 of 62 patients; p p p = 0.02), previous repaired abdominal aortic aneurysm (OR, 7.0; p = 0.005), type C aneurysm (OR, 13.73; p = 0.02), and cerebrovascular disease history (OR, 4.7; p p p Conclusions Repairs of the descending thoracic aorta using the adjunct of distal aortic perfusion and Cerebrospinal Fluid Drainage can be performed with a low incidence of neurologic deficit and an acceptable mortality. The use of the adjuncts should be considered during elective repairs of the descending thoracic aorta.

  • neurologic outcome after thoracic and thoracoabdominal aortic aneurysm repair
    The Annals of Thoracic Surgery, 2001
    Co-Authors: Anthony L Estrera, Charles C Miller, Eyal E Porat, Thi Thanh Tam Huynh, Hazim J Safi
    Abstract:

    Abstract Background . Neurologic deficit (paraparesis and paraplegia) after repair of the thoracic and thoracoabdominal aorta remains a devastating complication. The purpose of this study was to determine the effect of Cerebrospinal Fluid Drainage and distal aortic perfusion upon neurologic outcome during repair of thoracic and thoracoabdominal aortic aneurysm (TAAA) repair. Methods . Between February 1991 and March 2000, we performed 654 repairs of the thoracic and thoracoabdominal aorta. The median age was 67 years and 420 (64%) patients were male. Forty-five cases (6.9%) were performed emergently. Distribution of TAAA was the following: extent I, 164 (25%); extent II, 165 (25%); extent III, 61 (9%); extent IV, 95 (15%); extent V, 23 (3.5%); and descending thoracic, 147 (22%). The adjuncts Cerebrospinal Fluid Drainage and distal aortic perfusion were used in 428 cases (65%). Results . Thirty-day mortality was 14% (94 of 654). The in-hospital mortality was 16% (106 of 654). Early neurologic deficits occurred in 33 patients (5.0%). Overall, 14 of 428 (3.3%) neurologic deficits were observed in the adjunct group, and 19 of 226 (8.4%) in the nonadjunct group ( p = 0.004). When the adjuncts were used during extent II repair, the incidence was 10 of 129 (7.8%) compared with 11 of 36 (30.6%) in the nonadjunct group ( p p 0.05). Conclusions . The combined adjuncts of distal aortic perfusion and Cerebrospinal Fluid Drainage demonstrated improved neurologic outcome with repair of thoracic and TAAAs. In extent II aneurysms, adjuncts continue to make a considerable difference in the outcome and to provide significant protection against spinal cord morbidity. Future research should focus on spinal cord protection in patients with high-risk extent II aneurysms.

  • descending thoracic aortic aneurysm surgical approach and treatment using the adjuncts Cerebrospinal Fluid Drainage and distal aortic perfusion
    The Annals of Thoracic Surgery, 2001
    Co-Authors: Anthony L Estrera, Charles C Miller, Thi Thanh Tam Huynh, Forrest S Rubenstein, George V Letsou, Hazim J Safi
    Abstract:

    Abstract Background . Neurologic deficit (paraplegia or paraparesis) remains a significant morbidity in the repair of descending thoracic aortic aneurysm. Methods . Between February 1991 and February 2000, we operated on 182 patients for descending thoracic aortic aneurysm. For the purpose of this study—to identify the impact of the combined adjuncts distal aortic perfusion and Cerebrospinal Fluid (CSF) Drainage on neurologic outcome—we selected the 148 of 182 nonemergent patients who had received conventional treatment (simple cross-clamping with or without adjuncts). The mean patient age was 61 years, and 49 of the 148 (33%) patients were women. Nine of the 148 patients (6%) had acute type B dissections. We compared the results of 105 of the 148 patients (71%) who received the combined adjuncts of CSF Drainage and distal aortic perfusion with the remaining 43 (29%) patients who underwent repair using the simple cross-clamp with or without the addition of a single adjunct. Results . Overall 30-day mortality was 13 of 148 patients (8.8%). Overall early neurologic deficit was 4 of 148 (2.7%): 1 of 105 (0.9%) patients who had received distal aortic perfusion and CSF Drainage, versus 3 of 43 (7%) in all other patients ( p Conclusions . In our practice the use of the combined adjuncts of CSF Drainage and distal aortic perfusion has all but eliminated the incidence of immediate postoperative neurologic deficit in nonemergent patients with aneurysms of the descending thoracic aorta.

  • spinal cord protection in descending thoracic and thoracoabdominal aortic repair
    The Annals of Thoracic Surgery, 1999
    Co-Authors: Hazim J Safi, Charles C Miller
    Abstract:

    Abstract Background . During simple cross-clamp repair of the descending thoracic or thoracoabdominal aorta, the likelihood of neurologic complications increases greatly after only 30 minutes of spinal cord ischemia. At greatest risk are patients with type II thoracoabdominal aortic aneurysms. Methods . We reviewed our experience of simple cross-clamp repair and procedures accompanied by adjuncts, paying particular attention to the outcome of patients who had type II thoracoabdominal aortic aneurysms. Between February 1991 and March 1998, 508 patients had descending thoracic and thoracoabdominal aortic repair, 255 (50.2%) of whom received the adjuncts of Cerebrospinal Fluid Drainage and distal aortic perfusion. Results . Fifteen patients died on the day of operation and could not be evaluated for neurologic deficit. The overall incidence of neurologic deficit was 33 of 493 patients (6.7%). In patients who received adjuncts, neurologic deficit occurred in 9 of 247 (3.6%) overall; in types I and II it was 8 of 164 (4.9%), and in type II alone, 7 of 87 (8.1%). Neurologic deficit in simple cross-clamp patients was 24 of 246 (9.8%) overall; in types I and II it was 15 of 99 (15.2%), and in type II alone, 13 of 44 (29.6%). Conclusions . With the surgical adjuncts of Cerebrospinal Fluid Drainage and distal aortic perfusion, the probability of neurologic deficit is lowered appreciably.

Charles C Miller - One of the best experts on this subject based on the ideXlab platform.

  • Cerebrospinal Fluid Drainage during thoracic aortic repair safety and current management
    The Annals of Thoracic Surgery, 2009
    Co-Authors: Anthony L Estrera, Charles C Miller, Ali Azizzadeh, Roy Sheinbaum, Jon Cecil Walkes, Taek Yeon Lee, Larry R Kaiser, Hazim J Safi
    Abstract:

    Background The benefit of Cerebrospinal Fluid (CSF) Drainage during thoracic aortic repair has been established. Few studies, however, report management and safety of CSF Drainage. Methods Between September 1992 and August 2007, 1,353 repairs of the thoracic aorta were performed, with 82% using CSF Drainage. The CSF Drainage was not used in cases of rupture, acute trauma, infection, or prior paraplegia. Thirty-one percent (76 of 246) of patients without CSF Drainage were repaired prior to standardized use. All drains were inserted by cardiovascular anesthesia staff. Repairs were performed using distal aortic perfusion with heparinization. Early management involved free Drainage to maintain CSF pressure less than10 mm Hg, but was later modified to limit CSF Drainage unless neurologic deficit occurred. Results Cerebrospinal Fluid Drainage was technically achieved in 99.8% (1,105 of 1,107) of cases. The CSF catheter-related complications occurred in 1.5% (17 of 1,107) of patients. No spinal hematomas were observed. The CSF leaks with spinal headache, CSF leak without spinal headache, spinal headache, intracranial hemorrhage, catheter fracture, and meningitis occurred in 6 (0.54%), 1 (0.1%), 2 (0.2%), 5 (0.45%), 1 (0.1%), and 2 (0.2%) cases, respectively. Mortality from subdural hematoma was 40% (2 of 5), and from meningitis was 50% (1 of 2). Spinal headaches resolved with conservative management. All CSF leaks resolved, but 71% (5/7) required blood patches. Since implementation of a limited CSF Drainage protocol, no subdural hematomas have been observed. Conclusions Cerebrospinal Fluid Drainage for thoracic aortic repairs can be performed safely with excellent technical success. Perioperative management of CSF drains requires diligent monitoring and judicious Drainage. Standardizing CSF management may be beneficial.

  • descending thoracic aortic aneurysm repair 12 year experience using distal aortic perfusion and Cerebrospinal Fluid Drainage
    The Annals of Thoracic Surgery, 2005
    Co-Authors: Anthony L Estrera, Charles C Miller, Edward P Chen, Riad Meada, Ricardo H Torres, Eyal E Porat, Thi Thanh Tam Huynh, Ali Azizzadeh, Hazim J Safi
    Abstract:

    Background The benefit of distal aortic perfusion and Cerebrospinal Fluid Drainage over the "clamp and sew" technique during repairs of the descending thoracic aorta is still being debated. The purpose of this report is to analyze our experience with regard to neurologic deficit (paraplegia and paraparesis) and mortality using the adjuncts of distal aortic perfusion and Cerebrospinal Fluid Drainage. Methods Between February 1991 and September 2004, we repaired 355 descending thoracic aortic aneurysms. Excluded from analysis were 29 patients who required profound hypothermic circulatory arrest as a result of transverse arch involvement and 26 patients with aortic rupture, leaving a group of 300 patients for which outcomes were analyzed. Mean patient age was 67 years, and 102 (34%) of the patients were women. The adjunct group of distal aortic perfusion and Cerebrospinal Fluid Drainage used in 238 (79.3%) patients was compared with a group of 62 patients who underwent simple cross-clamp with or without the addition of a single adjunct. Multivariable data were analyzed by Cox regression. Results The incidence of neurologic deficit after all repairs was 2.3% (7 of 300 patients). The incidence of neurologic deficit (immediate and delayed) in the adjunct group was 1.3% (3 of 238 patients), and in the nonadjunct group was 6.5% (4 of 62 patients; p p p = 0.02), previous repaired abdominal aortic aneurysm (OR, 7.0; p = 0.005), type C aneurysm (OR, 13.73; p = 0.02), and cerebrovascular disease history (OR, 4.7; p p p Conclusions Repairs of the descending thoracic aorta using the adjunct of distal aortic perfusion and Cerebrospinal Fluid Drainage can be performed with a low incidence of neurologic deficit and an acceptable mortality. The use of the adjuncts should be considered during elective repairs of the descending thoracic aorta.

  • neurologic outcome after thoracic and thoracoabdominal aortic aneurysm repair
    The Annals of Thoracic Surgery, 2001
    Co-Authors: Anthony L Estrera, Charles C Miller, Eyal E Porat, Thi Thanh Tam Huynh, Hazim J Safi
    Abstract:

    Abstract Background . Neurologic deficit (paraparesis and paraplegia) after repair of the thoracic and thoracoabdominal aorta remains a devastating complication. The purpose of this study was to determine the effect of Cerebrospinal Fluid Drainage and distal aortic perfusion upon neurologic outcome during repair of thoracic and thoracoabdominal aortic aneurysm (TAAA) repair. Methods . Between February 1991 and March 2000, we performed 654 repairs of the thoracic and thoracoabdominal aorta. The median age was 67 years and 420 (64%) patients were male. Forty-five cases (6.9%) were performed emergently. Distribution of TAAA was the following: extent I, 164 (25%); extent II, 165 (25%); extent III, 61 (9%); extent IV, 95 (15%); extent V, 23 (3.5%); and descending thoracic, 147 (22%). The adjuncts Cerebrospinal Fluid Drainage and distal aortic perfusion were used in 428 cases (65%). Results . Thirty-day mortality was 14% (94 of 654). The in-hospital mortality was 16% (106 of 654). Early neurologic deficits occurred in 33 patients (5.0%). Overall, 14 of 428 (3.3%) neurologic deficits were observed in the adjunct group, and 19 of 226 (8.4%) in the nonadjunct group ( p = 0.004). When the adjuncts were used during extent II repair, the incidence was 10 of 129 (7.8%) compared with 11 of 36 (30.6%) in the nonadjunct group ( p p 0.05). Conclusions . The combined adjuncts of distal aortic perfusion and Cerebrospinal Fluid Drainage demonstrated improved neurologic outcome with repair of thoracic and TAAAs. In extent II aneurysms, adjuncts continue to make a considerable difference in the outcome and to provide significant protection against spinal cord morbidity. Future research should focus on spinal cord protection in patients with high-risk extent II aneurysms.

  • descending thoracic aortic aneurysm surgical approach and treatment using the adjuncts Cerebrospinal Fluid Drainage and distal aortic perfusion
    The Annals of Thoracic Surgery, 2001
    Co-Authors: Anthony L Estrera, Charles C Miller, Thi Thanh Tam Huynh, Forrest S Rubenstein, George V Letsou, Hazim J Safi
    Abstract:

    Abstract Background . Neurologic deficit (paraplegia or paraparesis) remains a significant morbidity in the repair of descending thoracic aortic aneurysm. Methods . Between February 1991 and February 2000, we operated on 182 patients for descending thoracic aortic aneurysm. For the purpose of this study—to identify the impact of the combined adjuncts distal aortic perfusion and Cerebrospinal Fluid (CSF) Drainage on neurologic outcome—we selected the 148 of 182 nonemergent patients who had received conventional treatment (simple cross-clamping with or without adjuncts). The mean patient age was 61 years, and 49 of the 148 (33%) patients were women. Nine of the 148 patients (6%) had acute type B dissections. We compared the results of 105 of the 148 patients (71%) who received the combined adjuncts of CSF Drainage and distal aortic perfusion with the remaining 43 (29%) patients who underwent repair using the simple cross-clamp with or without the addition of a single adjunct. Results . Overall 30-day mortality was 13 of 148 patients (8.8%). Overall early neurologic deficit was 4 of 148 (2.7%): 1 of 105 (0.9%) patients who had received distal aortic perfusion and CSF Drainage, versus 3 of 43 (7%) in all other patients ( p Conclusions . In our practice the use of the combined adjuncts of CSF Drainage and distal aortic perfusion has all but eliminated the incidence of immediate postoperative neurologic deficit in nonemergent patients with aneurysms of the descending thoracic aorta.

  • spinal cord protection in descending thoracic and thoracoabdominal aortic repair
    The Annals of Thoracic Surgery, 1999
    Co-Authors: Hazim J Safi, Charles C Miller
    Abstract:

    Abstract Background . During simple cross-clamp repair of the descending thoracic or thoracoabdominal aorta, the likelihood of neurologic complications increases greatly after only 30 minutes of spinal cord ischemia. At greatest risk are patients with type II thoracoabdominal aortic aneurysms. Methods . We reviewed our experience of simple cross-clamp repair and procedures accompanied by adjuncts, paying particular attention to the outcome of patients who had type II thoracoabdominal aortic aneurysms. Between February 1991 and March 1998, 508 patients had descending thoracic and thoracoabdominal aortic repair, 255 (50.2%) of whom received the adjuncts of Cerebrospinal Fluid Drainage and distal aortic perfusion. Results . Fifteen patients died on the day of operation and could not be evaluated for neurologic deficit. The overall incidence of neurologic deficit was 33 of 493 patients (6.7%). In patients who received adjuncts, neurologic deficit occurred in 9 of 247 (3.6%) overall; in types I and II it was 8 of 164 (4.9%), and in type II alone, 7 of 87 (8.1%). Neurologic deficit in simple cross-clamp patients was 24 of 246 (9.8%) overall; in types I and II it was 15 of 99 (15.2%), and in type II alone, 13 of 44 (29.6%). Conclusions . With the surgical adjuncts of Cerebrospinal Fluid Drainage and distal aortic perfusion, the probability of neurologic deficit is lowered appreciably.

Anthony L Estrera - One of the best experts on this subject based on the ideXlab platform.

  • Cerebrospinal Fluid Drainage during thoracic aortic repair safety and current management
    The Annals of Thoracic Surgery, 2009
    Co-Authors: Anthony L Estrera, Charles C Miller, Ali Azizzadeh, Roy Sheinbaum, Jon Cecil Walkes, Taek Yeon Lee, Larry R Kaiser, Hazim J Safi
    Abstract:

    Background The benefit of Cerebrospinal Fluid (CSF) Drainage during thoracic aortic repair has been established. Few studies, however, report management and safety of CSF Drainage. Methods Between September 1992 and August 2007, 1,353 repairs of the thoracic aorta were performed, with 82% using CSF Drainage. The CSF Drainage was not used in cases of rupture, acute trauma, infection, or prior paraplegia. Thirty-one percent (76 of 246) of patients without CSF Drainage were repaired prior to standardized use. All drains were inserted by cardiovascular anesthesia staff. Repairs were performed using distal aortic perfusion with heparinization. Early management involved free Drainage to maintain CSF pressure less than10 mm Hg, but was later modified to limit CSF Drainage unless neurologic deficit occurred. Results Cerebrospinal Fluid Drainage was technically achieved in 99.8% (1,105 of 1,107) of cases. The CSF catheter-related complications occurred in 1.5% (17 of 1,107) of patients. No spinal hematomas were observed. The CSF leaks with spinal headache, CSF leak without spinal headache, spinal headache, intracranial hemorrhage, catheter fracture, and meningitis occurred in 6 (0.54%), 1 (0.1%), 2 (0.2%), 5 (0.45%), 1 (0.1%), and 2 (0.2%) cases, respectively. Mortality from subdural hematoma was 40% (2 of 5), and from meningitis was 50% (1 of 2). Spinal headaches resolved with conservative management. All CSF leaks resolved, but 71% (5/7) required blood patches. Since implementation of a limited CSF Drainage protocol, no subdural hematomas have been observed. Conclusions Cerebrospinal Fluid Drainage for thoracic aortic repairs can be performed safely with excellent technical success. Perioperative management of CSF drains requires diligent monitoring and judicious Drainage. Standardizing CSF management may be beneficial.

  • descending thoracic aortic aneurysm repair 12 year experience using distal aortic perfusion and Cerebrospinal Fluid Drainage
    The Annals of Thoracic Surgery, 2005
    Co-Authors: Anthony L Estrera, Charles C Miller, Edward P Chen, Riad Meada, Ricardo H Torres, Eyal E Porat, Thi Thanh Tam Huynh, Ali Azizzadeh, Hazim J Safi
    Abstract:

    Background The benefit of distal aortic perfusion and Cerebrospinal Fluid Drainage over the "clamp and sew" technique during repairs of the descending thoracic aorta is still being debated. The purpose of this report is to analyze our experience with regard to neurologic deficit (paraplegia and paraparesis) and mortality using the adjuncts of distal aortic perfusion and Cerebrospinal Fluid Drainage. Methods Between February 1991 and September 2004, we repaired 355 descending thoracic aortic aneurysms. Excluded from analysis were 29 patients who required profound hypothermic circulatory arrest as a result of transverse arch involvement and 26 patients with aortic rupture, leaving a group of 300 patients for which outcomes were analyzed. Mean patient age was 67 years, and 102 (34%) of the patients were women. The adjunct group of distal aortic perfusion and Cerebrospinal Fluid Drainage used in 238 (79.3%) patients was compared with a group of 62 patients who underwent simple cross-clamp with or without the addition of a single adjunct. Multivariable data were analyzed by Cox regression. Results The incidence of neurologic deficit after all repairs was 2.3% (7 of 300 patients). The incidence of neurologic deficit (immediate and delayed) in the adjunct group was 1.3% (3 of 238 patients), and in the nonadjunct group was 6.5% (4 of 62 patients; p p p = 0.02), previous repaired abdominal aortic aneurysm (OR, 7.0; p = 0.005), type C aneurysm (OR, 13.73; p = 0.02), and cerebrovascular disease history (OR, 4.7; p p p Conclusions Repairs of the descending thoracic aorta using the adjunct of distal aortic perfusion and Cerebrospinal Fluid Drainage can be performed with a low incidence of neurologic deficit and an acceptable mortality. The use of the adjuncts should be considered during elective repairs of the descending thoracic aorta.

  • neurologic outcome after thoracic and thoracoabdominal aortic aneurysm repair
    The Annals of Thoracic Surgery, 2001
    Co-Authors: Anthony L Estrera, Charles C Miller, Eyal E Porat, Thi Thanh Tam Huynh, Hazim J Safi
    Abstract:

    Abstract Background . Neurologic deficit (paraparesis and paraplegia) after repair of the thoracic and thoracoabdominal aorta remains a devastating complication. The purpose of this study was to determine the effect of Cerebrospinal Fluid Drainage and distal aortic perfusion upon neurologic outcome during repair of thoracic and thoracoabdominal aortic aneurysm (TAAA) repair. Methods . Between February 1991 and March 2000, we performed 654 repairs of the thoracic and thoracoabdominal aorta. The median age was 67 years and 420 (64%) patients were male. Forty-five cases (6.9%) were performed emergently. Distribution of TAAA was the following: extent I, 164 (25%); extent II, 165 (25%); extent III, 61 (9%); extent IV, 95 (15%); extent V, 23 (3.5%); and descending thoracic, 147 (22%). The adjuncts Cerebrospinal Fluid Drainage and distal aortic perfusion were used in 428 cases (65%). Results . Thirty-day mortality was 14% (94 of 654). The in-hospital mortality was 16% (106 of 654). Early neurologic deficits occurred in 33 patients (5.0%). Overall, 14 of 428 (3.3%) neurologic deficits were observed in the adjunct group, and 19 of 226 (8.4%) in the nonadjunct group ( p = 0.004). When the adjuncts were used during extent II repair, the incidence was 10 of 129 (7.8%) compared with 11 of 36 (30.6%) in the nonadjunct group ( p p 0.05). Conclusions . The combined adjuncts of distal aortic perfusion and Cerebrospinal Fluid Drainage demonstrated improved neurologic outcome with repair of thoracic and TAAAs. In extent II aneurysms, adjuncts continue to make a considerable difference in the outcome and to provide significant protection against spinal cord morbidity. Future research should focus on spinal cord protection in patients with high-risk extent II aneurysms.

  • descending thoracic aortic aneurysm surgical approach and treatment using the adjuncts Cerebrospinal Fluid Drainage and distal aortic perfusion
    The Annals of Thoracic Surgery, 2001
    Co-Authors: Anthony L Estrera, Charles C Miller, Thi Thanh Tam Huynh, Forrest S Rubenstein, George V Letsou, Hazim J Safi
    Abstract:

    Abstract Background . Neurologic deficit (paraplegia or paraparesis) remains a significant morbidity in the repair of descending thoracic aortic aneurysm. Methods . Between February 1991 and February 2000, we operated on 182 patients for descending thoracic aortic aneurysm. For the purpose of this study—to identify the impact of the combined adjuncts distal aortic perfusion and Cerebrospinal Fluid (CSF) Drainage on neurologic outcome—we selected the 148 of 182 nonemergent patients who had received conventional treatment (simple cross-clamping with or without adjuncts). The mean patient age was 61 years, and 49 of the 148 (33%) patients were women. Nine of the 148 patients (6%) had acute type B dissections. We compared the results of 105 of the 148 patients (71%) who received the combined adjuncts of CSF Drainage and distal aortic perfusion with the remaining 43 (29%) patients who underwent repair using the simple cross-clamp with or without the addition of a single adjunct. Results . Overall 30-day mortality was 13 of 148 patients (8.8%). Overall early neurologic deficit was 4 of 148 (2.7%): 1 of 105 (0.9%) patients who had received distal aortic perfusion and CSF Drainage, versus 3 of 43 (7%) in all other patients ( p Conclusions . In our practice the use of the combined adjuncts of CSF Drainage and distal aortic perfusion has all but eliminated the incidence of immediate postoperative neurologic deficit in nonemergent patients with aneurysms of the descending thoracic aorta.

Muhammad S Hussain - One of the best experts on this subject based on the ideXlab platform.

  • Cerebrospinal Fluid Drainage and blood pressure elevation to treat acute spinal cord infarct
    Surgical Neurology International, 2018
    Co-Authors: Tamara Strohm, Seby John, Muhammad S Hussain
    Abstract:

    Background Current management of acute spinal cord infarction (SCI) is limited. Lumbar Cerebrospinal Fluid Drainage (CSFD) with blood pressure augmentation is utilized in the thoracic/thoracoabdominal aortic repair and thoracic endovascular aortic repair (TEVAR) populations to increase spinal perfusion pressure. Case description We identified 3 patients who sustained acute SCI and underwent CSFD and maintenance of elevated mean arterial pressure (MAP) within 24 hours of injury. The first patient exhibited delayed-onset ischemia after a TEVAR. The second patient presented with an acute type B aortic intramural hematoma. The third patient developed spinal cord ischemia following bronchial artery embolization. There was significant improvement in the motor examination (e.g., ASIA impairment scale grade B or C) to grade D utilizing both blood pressure augmentation and CSFD. Conclusions Lumbar CSFD with MAP elevation benefited 3 patients with acute SCI of varying etiologies.

  • Cerebrospinal Fluid Drainage for acute spinal cord infarction p1 301
    Neurology, 2017
    Co-Authors: Tamara Strohm, Seby John, Muhammad S Hussain
    Abstract:

    Objective: We report three cases of patients with acute spinal cord infarction (SCI) with improvement in weakness after lumbar drain placement. Background: Numerous studies have shown CSF Drainage via lumbar drain is effective in preventing SCI for patients undergoing thoracoabdominal aortic aneurysm surgery. When combined with augmentation of systemic blood pressure, CSF Drainage reduces risk of spinal cord infarction by minimizing the resistance to afferent spinal cord blood supply and increasing perfusion pressure. By the same mechanism, patients with acute spinal cord infarction (SCI) may benefit from lumbar drain placement, though this has not been previously studied. Design/Methods: A retrospective review from 2013–2016 of three patients diagnosed with acute SCI who underwent lumbar drain placement. Results: Case one: 77 year old male with atrial fibrillation underwent endovascular thoracic aortic aneurysm repair. His lumbar drain was discontinued two days later. Seven days post operatively he developed complete paraplegia. MRI lumbar spine showed T2 hyperintensity at T12-L1 concerning for SCI. Lumbar drain was replaced with improvement in examination and ambulatory status at discharge. Case two: 61 year old male with hypertension presented with acute bilateral lower extremity weakness. CTA showed a type B distribution intramural hematoma from the origin of the subclavian artery into the abdomen. MRI was unremarkable but given strong clinical suspicion for SCI, lumbar drain was placed with significant improvement in weakness. Case three: 61 year old male who underwent pulmonary artery embolization and developed acute unilateral lower extremity weakness and sensory deficit following the procedure. MRI showed diffusion restriction at T2/T3. Lumbar drain was placed and the patient improved over several days with discharge to acute rehabilitation. Conclusions: CSF Drainage with blood pressure augmentation may be beneficial in patients with acute SCI of varying etiologies. More studies are needed to determine the utility of this finding. Disclosure: Dr. Strohm has nothing to disclose. Dr. John has nothing to disclose. Dr. Hussain has nothing to disclose.

Joseph S Coselli - One of the best experts on this subject based on the ideXlab platform.

  • complications of Cerebrospinal Fluid Drainage after thoracic aortic surgery a review of 504 patients over 5 years
    The Journal of Thoracic and Cardiovascular Surgery, 2013
    Co-Authors: Joseph S Coselli, Scott A Lemaire, Sloan C Youngblood, Daniel A Tolpin, Veivei Lee, John R Cooper
    Abstract:

    Background Cerebrospinal Fluid Drainage, a well-established means of preventing paraplegia after thoracic aortic aneurysm surgery, can result in serious, sometimes lethal complications. In a large group of patients who underwent surgical thoracic aortic aneurysm repair with Cerebrospinal Fluid Drainage, we examined the incidences of and potential risk factors for these outcomes. Methods The records were reviewed of 504 patients who underwent surgical thoracic aortic aneurysm repair with Cerebrospinal Fluid Drainage at the Texas Heart Institute at St. Luke's Episcopal Hospital between February 2005 and December 2009. All historical data, inpatient records, and billing data were searched for evidence of complications. Results Of the 504 patients, 14 (2.8%) had intracranial hemorrhage, of whom 10 (72%) had subdural hematoma. Postdural puncture headache developed in 49 patients (9.7%), of whom 17 (34.6%) required epidural blood patch placement for resolution. Multivariable analysis identified having a connective tissue disorder (odds ratio, 3.08; 95% confidence interval, 1.33-7.13) as an independent predictor of postdural puncture headache, but not age less than 40 years (odds ratio, 0.97; 95% confidence interval, 0.94-0.99). Conclusions Cerebrospinal Fluid Drainage, as performed by our method, seems to be associated with a modest rate of intracranial bleeding in patients who undergo surgical thoracic aortic aneurysm repair. In contrast, postdural puncture headache is not uncommon, particularly in patients with connective tissue disease. Clinicians caring for these patients should consider the likelihood of postdural puncture headache, and any such patient with postoperative headache should be assessed for epidural blood patch placement.

  • Cerebrospinal Fluid Drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair results of a randomized clinical trial
    Journal of Vascular Surgery, 2002
    Co-Authors: Joseph S Coselli, Scott A Lemaire, Cuneyt Koksoy, Zachary C Schmittling, Patrick E Curling
    Abstract:

    Abstract Objective: Despite the use of various strategies for the prevention of spinal cord ischemia, paraplegia and paraparesis continue to occur after thoracoabdominal aortic aneurysm (TAAA) repair. Although Cerebrospinal Fluid Drainage (CSFD) is often used as an adjunct for spinal cord protection, its benefit remains unproven. The purpose of this randomized clinical trial was to evaluate the impact of CSFD on the incidence of spinal cord injury after extensive TAAA repair. Methods: After randomization, 145 patients underwent extent I or II TAAA repairs with a consistent strategy of moderate heparinization, permissive mild hypothermia, left heart bypass, and reattachment of patent critical intercostal arteries. The repairs were performed with CSFD (n = 76) or without CSFD (n = 69). In the former group, CSFD was initiated during the operation and continued for 48 hours after surgery. The target CSF pressure was 10 mm Hg or less. Results: The two groups had similar risk factors for paraplegia. Aortic clamp time, left heart bypass time, and number of reattached intercostal arteries were also similar in both groups. Thirty-day mortality rates were 5.3% (four patients) and 2.9% (two patients) for CSFD and control groups, respectively ( P =.68). Nine patients (13.0%) in the control group had paraplegia or paraparesis develop. In contrast, only two patients in the CSFD group (2.6%) had deficits develop ( P =.03). No patients with CSFD had immediate paraplegia. Overall, CSFD resulted in an 80% reduction in the relative risk of postoperative deficits. Conclusion: Perioperative CSFD reduces the rate of paraplegia after repair of extent I and II TAAAs. (J Vasc Surg 2002;35;631-9.)

  • Cerebrospinal Fluid Drainage in thoracoabdominal aortic surgery
    Seminars in Vascular Surgery, 2000
    Co-Authors: Joseph S Coselli, Scott A Lemaire, Zachary C Schmittling, Cuneyt Koksoy
    Abstract:

    Paraplegia caused by spinal cord ischemia remains a devastating complication after surgical repair of thoracoabdominal aortic aneurysms. Cerebrospinal Fluid (CSF) Drainage has been advocated as a protective adjunct to reduce the incidence of postoperative neurologic deficits. Studies in animals have shown that CSF Drainage during thoracic aortic clamping reduces CSF pressure, improves spinal cord blood flow, and prevents paraplegia. Previous retrospective and randomized clinical studies, however, have been inconclusive because of confounding factors and other limitations. A recent prospective randomized trial focusing solely on CSF Drainage during repair of extent I and II thoracoabdominal aortic aneurysms indicated an 80% reduction in the relative risk of paraplegia and paraparesis in patients who received this adjunct. Consequently, CSF Drainage has emerged as an important addition to the multimodality strategy for preventing postoperative spinal cord deficits.

  • a prospective randomized study of Cerebrospinal Fluid Drainage to prevent paraplegia after high risk surgery on the thoracoabdominal aorta
    Journal of Vascular Surgery, 1991
    Co-Authors: Stanley E Crawford, Joseph S Coselli, Lars G Svensson, Hazim J Safi, Kenneth R Hess, Salwa S Shenaq, Prita K Mohindra, Victor M Rivera
    Abstract:

    This article is concerned with the study of the effect of several variables, principally that of Cerebrospinal Fluid Drainage, on the incidence of neurologic deficit in a prospective randomized series of patients with extensive aneurysms of the descending thoracic and abdominal aorta (thoracoabdominal type I and II). Forty-six patients had Cerebrospinal Fluid Drainage, and 52 were controls, with a total of 98 available for study. Cerebrospinal Fluid pressure was continuously monitored in the former group and pressure maintained less than or equal to 10 mm Hg in 20, less than or equal to 15 mm Hg in 20, and greater than 15 mm Hg in 6 patients during period of aortic clamping. The method of treatment including reattachment of intercostal and lumbar arteries (p = 0.2), temporary atriofemoral bypass during aortic occlusion (p = 0.3), and spinal Fluid Drainage (p = 0.8) were not statistically significant in reducing the incidence of neurologic deficits. Thus Cerebrospinal Fluid Drainage as we used it, was not beneficial in preventing paraplegia. On appropriate statistical analysis we found that the only significant predictor of delayed deficits was postoperative hypotension (p = 0.006).