The Potential Causes of Paraplegia after Coronary Artery Bypass Grafting: A Literature Review
Paraplegia after CABG - the Summary of Possible Causes
Keywords:coronary artery bypass grafting, paraplegia, spinal cord, review
Paraplegia is an unpredictable neurologic complication after coronary artery bypass grafting (CABG) surgery. It is rare but fatal, and the mechanism still is unclear. We aimed to make a summary of the possible causes of paraplegia after CABG. Pubmed database was searched from January 1, 1978 to December 31, 2019, and 14 studies were finally included. Paraplegia after CABG is a multifactorial consequence, but spinal cord ischemia is the key pathological factor to postoperative paraplegia.
Archer AG, Choyke PL, Zeman RK, et al. 1986. Aortic dissection following coronary artery bypass surgery: diagnosis by CT. Cardiovasc Intervent Radiol. 9(3):142-5.
Bican O, Minagar A, Pruitt AA. 2013. The spinal cord: a review of functional neuroanatomy. Neurol Clin. 31(1):1-18.
Bondurant FJ, Cotler HB, Kulkarni MV, et al. 1990. Acute spinal cord injury: a study using physical examination and magnetic resonance imaging. Spine (Phila Pa 1976). 15:630-8.
Colak N, Nazli Y, Alpay MF, et al. 2012. Painless aortic dissection presenting as paraplegia. Tex Heart Inst J. 39(2):273-6.
Coselli JS, LeMaire SA, Schmittling ZC, Koksoy C. 2000. Cerebrospinal fluid drainage in thoracoabdominal aortic surgery. Semin Vasc Surg. 13(4):308-314.
Donohoe DR. 2000. Neurologic system: physiology, assessment, and intracranial hypertension. In: Pass CCRN 2nd ed. St. Louis, Mo: CV Mosby. 293-346.
Feng WC, Singh AK, Bert AA, et al. 1993. Perioperative paraplegia and multiorgan failure from heparin-induced thrombocytopenia. Ann Thorac Surg. 55(6): 1555-7.
Garg A, Bansal A, Bhuyan S, et al. 2014. Paraplegia during coronary artery bypass graft surgery caused by bilateral anterior cerebral artery territory infarction. Ann Transl Med. 2(5):49.
Haidari A, Sabzi F, Dabiri S. 2017. Paraplegia after Off-Pump Coronary Artery By-Pass Grafting. Acta Med Iran. 55(12):807-11.
Harris RE, Reimer KA, Crain BJ, et al. 1986. Spinal cord infarction following intraaortic balloon support. Ann Thorac Surg. 42(2):206-7.
Heldner MR, Arnold M, Nedeltchev K, et al. 2012. Vascular diseases of the spinal cord: A review. Curr Treat Options Neurol. 14(6):509–20.
Kin H, Mukaida M, Koizumi J, et al. 2016. Spontaneous spinal epidural hematoma presenting as paraplegia after cardiac surgery. Gen Thorac Cardiovasc Surg. 64(3):153–5.
Macoviak J, Stephenson LW, Edmunds LH Jr, et al. 1980. The intraaortic baloon pump: an analysis of five years' experience. Ann Thorac Surg. 29(5):451-8.
Mehta DP, Yoder EL, Appel J, et al. 1991. Heparin-induced thrombocytopenia and thrombosis: reversal with streptokinase a case report and review of literature. Am J Hematol. 36: 275-9.
Miranda M, Hossne NA, de Vilela AT, et al. 2014. Paraplegia After Off-Pump Coronary Artery Bypass Grafting. The Annals of Thoracic Surgery. 97(1), 326–7.
Mirhosseini SM, Meghdadi S, Moghaddam AS. 2017. Anterior Spinal Artery Syndrome Following Coronary Artery Bypass Grafting: a Case Report. Braz J Cardiovasc Surg. 32(2):136-7.
Müller KI, Steffensen LH, Johnsen SH. 2012. Thrombolysis in anterior spinal artery syndrome. BMJ Case Rep. Sep 7. bcr2012006862.
Pouplard C, May MA, Iochmann S, et al. 1999. Antibodies to platelet factor 4-heparin after cardiopulmonary bypass in patients anticoagulated with unfractionated heparin or a low-molecular-weight heparin: clinical implications for heparin-induced thrombocytopenia. Circulation. 99(19):2530-6.
Sabzi F, Faraji R. 2015. Double incontinence as a first symptom of saddle embolism of the aorta leads to sudden paraplegia. Arch Iran Med. 18(11): 796-8.
Scherr K, Urquhart G, Eichorst C, et al. 2006. Paraplegia after coronary artery bypass graft surgery: case report of a rare event. Crit Care Nurse. 26(5): 34-6, 38-40, 42-5.
Subramaniam A, Pick A, Tiruvoipati R. 2017. Anterior spinal artery syndrome after double valve replacement and coronary artery bypass surgery. Clin Case Rep. 5(5):714-17.
Taterra D, Skinning Srud B, Pękala PA, et al. 2019. Reply by Tomaszewski et al. to the letter by Jiang et al. regarding “Artery of Adamkiewicz: a meta-analysis of anatomical characteristics.” Neuroradiology. 61(8):851-2.
Thomas NJ, Harvey AT. 1999. Paraplegia after coronary bypass operations: relationship to severe hypertension and vascular disease. J Thorac Cardiovasc Surg. Apr;117(4):834-6.
Tyras DH, Willman VL. 1978. Paraplegia following intraaortic balloon assistance. Ann Thorac Surg. 25(2):164-6.
White JM, Ruygrok PN. 2015. Intra-Aortic Balloon Counterpulsation in Contemporary Practice – Where Are We? Heart, Lung and Circulation. 24(4), 335–41.
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