| It is not just assisted circulation, hypothermic arrest, or clamp and sew. | |
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MedLine Citation:
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PMID: 21092780 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Charles Acher |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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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:
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Created Date: 2010-11-24 Completed Date: 2010-12-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: S136-41; discussion S142-S146 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010. Published by Mosby, Inc. |
Affiliation:
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Department of Surgery, University of Wisconsin, Madison, Wis., USA. acher.c@gmail.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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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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