Thoracoabdominal aortic aneurysm surgery: quest for organ protection and survival
Dr. Coselli received the award for his work in developing measures to reduce morbidity and mortality in thoracoabdominal aortic aneurysm. Dr. Coselli's research has focused upon the challenges encountered in the surgical treatment of patients suffering from aortic aneurysms, aortic dissection and Marfan syndrome. He has a particular interest in patients with extensive aneurysms involving both the chest and abdomen; i.e., thoracoabdominal aortic aneurysms. He has investigated the techniques to reduce the risks of surgical treatment of such aneurysms for both mortality and morbidity. The primary morbidities following such procedures include loss of function of the spinal cord and kidneys. In addition to curative operative intervention, organ protection and preservation are the focus of Dr. Coselli's research. To reduce spinal cord injury and its consequent development of paraplegia or paraparesis, perfusion beyond the location of repair using left heart bypass has been evaluated in a large series of patients. Cerebrospinal fluid drainage validated its favorable impact upon decreasing the incidence of paraplegia/paraparesis during a prospective randomized trial. Similarly, regarding preservation of kidney function, again using a prospective randomized evaluation, cold crystalloid perfusion reducing the kidney temperature was demonstrated to be superior to normothermic blood perfusion. Focusing upon mortality and major morbidity following thoracoabdominal aortic aneurysm repairs, Dr. Coselli has prospectively evaluated his large contemporary series to identify specific risk factors and develop predictive models for adverse outcomes. The latter serve as valuable tools for surgeons and patients deliberating operative intervention.
Dr. Coselli’s nomination was based on the following publications:
Coselli JS, LeMaire SA. Left heart bypass reduces paraplegia rates after thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 1999 Jun;67(6):1931-4; discussion 1953-8.
Coselli JS, LeMaire SA, Miller CC 3rd, Schmittling ZC, Koksoy C, Pagan J, Curling PE. Mortality and paraplegia after thoracoabdominal aortic aneurysm repair: a risk factor analysis. Ann Thorac Surg. 2000 Feb;69(2):409-14.
LeMaire SA, Miller CC 3rd, Conklin LD, Schmittling ZC, Koksoy C, Coselli JS. A new predictive model for adverse outcomes after elective thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 2001 Apr;71(4):1233-8.