Late cerebrospinal fluid drainage for paraplegia developed following Bentall procedure for acute type a aortic dissection

Methods A 51 year old woman who had chest and back pain and syncope, was admitted to emergency department. Thorax CT revealed acute type A aortic dissection and she underwent emergency surgery. Modified Bentall procedure along with hemiarch replacement was performed using antegrade selective cerebral perfusion. The next day she developed cardiac tamponade and ischemia of the left leg. Re-exploration did not reveal any active bleeding source and right-to-left femoro-femoral crossover bypass was performed with a 10 mm dacron graft during repeat sternotomy. Distal pulses were palpable for both legs after the procedure. On third postoperative day she required a second re-exploration for bleeding and tamponade. Due to hemodynamic instability she received inotropes, required prolonged sedation and dialysis. On postoperative day 5, sedation was terminated and she was extubated but her physical examination revealed paraplegia. Medical theraphy was started. CSF drainage was performed afterwards.