Document Detail


Neuromonitor-guided repair of thoracoabdominal aortic aneurysms.
MedLine Citation:
PMID:  21092779     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Monitoring during thoracoabdominal aortic aneurysm repair has included the use of cerebrospinal fluid drainage and motor and somatosensory evoked potentials. We report our experience with neuromonitoring-guided thoracoabdominal aortic aneurysm repair.
METHODS: Between November 2008 and January 2010, 105 thoracic aorta repairs were performed; 89% of patients (93/105) underwent repair using cerebrospinal fluid drainage and distal aortic perfusion. In addition, somatosensory and motor evoked potentials were monitored during repair, and active intraoperative maneuvers were undertaken in response to changes in the signals. Intraoperative maneuvers included intercostal artery reimplantation.
RESULTS: In-hospital mortality for thoracic and thoracoabdominal aortic repair was 5.7% (6/105). Immediate spinal cord injury occurred in 1 patient (1%), and 3 patients (3%) had delayed neurologic deficit. Intercostal arteries were reattached in 85% of possible cases (51/60). Somatosensory evoked potentials achieved adequate readings in 99% of cases (102/103). Loss of somatosensory evoked potential was encountered in 26% of cases (27/102), and return of somatosensory evoked potentials occurred in all cases after intraoperative maneuvers. Motor evoked potentials achieved adequate readings in 96% of cases (99/103). Loss of motor evoked potential was encountered in 50% of cases (50/99), and return of motor evoked potentials occurred in all but 1 case (95%). This patient awoke with an immediate spinal neurologic deficit.
CONCLUSIONS: Neuromonitoring using somatosensory evoked potentials and motor evoked potentials seems useful during thoracoabdominal aortic aneurysm repair. Alterations in intraoperative conduct resulted in return of neuromonitoring signals. This suggests a benefit in intercostal artery reimplantation via increasing perfusion to the collateral network of the spinal cord. Further studies using neuromonitoring-guided repair of thoracoabdominal aortic aneurysms are warranted.
Authors:
Anthony L Estrera; Roy Sheinbaum; Charles C Miller; Ryan Harrison; Hazim J Safi
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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:  S131-5; discussion S142-S146     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Cardiothoracic and Vascular Surgery, University of Texas Medical School Houston, Memorial Hermann Heart and Vascular Institute, Houston, TX, USA. Anthony.l.estrera@uth.tmc.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Aortic Aneurysm, Thoracic / mortality,  physiopathology,  surgery*
Cerebrospinal Fluid Shunts / adverse effects
Evoked Potentials, Motor*
Evoked Potentials, Somatosensory*
Female
Hospital Mortality
Humans
Male
Middle Aged
Monitoring, Intraoperative / methods*
Predictive Value of Tests
Replantation
Retrospective Studies
Spinal Cord Ischemia / diagnosis*,  etiology,  physiopathology,  prevention & control
Texas
Thoracic Arteries / surgery
Treatment Outcome
Vascular Surgical Procedures* / adverse effects,  mortality
Young Adult

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


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