Lumbar Drains After Cardiac Surgery: Evidence-Based Solutions for Safe Management

Paraplegia, one of the most significant postoperative complications for patients undergoing thoracic and thoracoabdominal aortic aneurysm surgery, results from too little perfusion to the spinal nerves.^1,2  Time with an aortic cross-clamp in place, hypothermia, and reperfusion injury are a few of the contributing factors. Wan et al³  reported that the risk of paraplegia with reconstructive surgery ranges between 5% and 40%, and potential improvements are achieved with distal aortic perfusion techniques and cerebrospinal fluid (CSF) drainage. Safi et al⁴  proposed a 16% to 31% risk of paraplegia with high-risk thoracoabdominal aortic aneurysm repair. This risk can increase to 50% with a cross-clamp in place longer than 45 minutes.⁴  The risk with thoracic endovascular repair is much lower at 1.5%, although that risk increases to 2.88% when protocols are not used, and to 5.6% when protocols are applied...