Abstract

Objective: During open descending thoracic and thoracoabdominal aortic aneurysm (DTAA/TAAA) repair, we utilized routine T8-T12 intercostal artery (ICA) reattachment strategy from July 2004-June 2009 and after 2017, while selective ICA reattachment strategy (reattaching T8-T12 ICAs only when neuromonitor signals were lost) from July 2009-2016.This study reviewed our near two-decade experience to assess the impact of two ICA reattachment strategies on spinal cord injury (SCI).Methods: All open DTAA/TAAA repairs performed from July 2004-June 2022 were included, except for cases without intraoperative cerebral spinal fluid drainage.Perioperative data were reviewed.Univariable and multivariable analyses and propensity matching for risk-adjusted effects of two strategies for ICA reattachment on SCI were used.Results: In all, 375 patients were operated on with selective strategy and 584 with routine strategy.Age and prevalence of rupture and redo were similar in the two groups.The rate of operative mortality and immediate SCI were also similar (selective vs. routine: mortality, 12.5% vs. 12.3%; immediate SCI, 3.2% vs. 2.2%).However, the incidence of delayed and permanent SCI was increased in the selective group (delayed, 10.4% vs. 6.9%;permanent, 8.5% vs. 5.3%).Multivariable analyses demonstrated selective strategy was a predictor of delayed and permanent SCI, along with TAAA extent II/III, and older age. Conclusion:Two strategies of ICA reattachment did not impact the incidence of immediate SCI, which was infrequent, but the selective strategy was associated with higher rates of delayed permanent SCI.Reattachment of the ICAs within T8-T12 should be performed during open DTAA/TAAA.