Document Detail


It is not just assisted circulation, hypothermic arrest, or clamp and sew.
MedLine Citation:
PMID:  21092780     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We have surgically treated 771 patients for thoracic and thoracoabdominal aortic aneurysms since 1983. Our primary effort has been to develop experimentally validated strategies to reduce paraplegia, renal failure, and mortality in these high-risk patients. This approach has led to a spinal cord protection protocol that has reduced paraplegia risk by 80% (observed/expected ratio = 0.19) with the use of cerebral spinal fluid drainage, moderate hypothermia (31°C-33°C), endorphin receptor antagonist (naloxone), and thiopental burst suppression while optimizing mean arterial pressure (> 90 mm Hg) and cardiac index. The elective mortality rate is 2.80% (17% for acute patients), and with rapid renal cooling for renal protection, only 0.88% required permanent dialysis. These results were achieved without the use of assisted circulation. We have reattached intercostal arteries since 2005 using preoperative magnetic resonance angiographic localization, but it remains unclear whether intercostal reimplantation reduces paraplegia risk, as we had initially proposed. We strongly believe that a consistent anesthetic and postoperative care protocol uniformly built and applied around these principles greatly enhances our surgical outcomes. We also show that improved outcomes with assisted circulation and hypothermic arrest in treatment of thoracoabdominal aortic disease follow similar principles of spinal cord and end-organ protection.
Authors:
Charles Acher
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  140     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2010-12-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S136-41; discussion S142-S146     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010. Published by Mosby, Inc.
Affiliation:
Department of Surgery, University of Wisconsin, Madison, Wis., USA. acher.c@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Anesthetics, Intravenous / administration & dosage
Aortic Aneurysm, Thoracic / mortality,  physiopathology,  surgery*
Assisted Circulation*
Cerebrospinal Fluid Shunts
Child
Constriction
Female
Heart Arrest, Induced*
Hemodynamics
Humans
Hypothermia, Induced*
Male
Middle Aged
Naloxone / administration & dosage
Narcotic Antagonists / administration & dosage
Paraplegia / etiology,  prevention & control
Postoperative Care
Renal Insufficiency / etiology,  prevention & control
Replantation
Risk Assessment
Risk Factors
Spinal Cord Ischemia / etiology,  prevention & control
Suture Techniques*
Thiopental / administration & dosage
Thoracic Arteries / surgery
Treatment Outcome
Vascular Surgical Procedures* / adverse effects,  mortality
Wisconsin
Young Adult
Chemical
Reg. No./Substance:
0/Anesthetics, Intravenous; 0/Narcotic Antagonists; 465-65-6/Naloxone; 76-75-5/Thiopental

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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