Document Detail

Surgical repair of thoracoabdominal aortic aneurysms.
MedLine Citation:
PMID:  17308522     Owner:  NLM     Status:  MEDLINE    
Morbidity and mortality following thoracoabdominal aortic aneurysm (TAAA) repair are tremendous. Preoperative assessment is essential in detecting cardiac and pulmonary risk factors in order to reduce cardiopulmonary complications. Paraplegia and renal failure are main determinants of postoperative mortality and therefore gained substantial attention during the last decades. Left heart bypass, cerebrospinal fluid (CSF) drainage and epidural cooling have significantly reduced paraplegia rate, however, this dreadful event still occurs in up to 25% of patients undergoing type II repair. Renal failure has been partly prevented by means of retrograde aortic perfusion and cooling but renal failure still remains a significant problem. We have evaluated the effects of protective measures aiming for reduction of paraplegia and renal failure. Monitoring motor evoked potentials (MEPs) is an accurate technique to assess spinal cord integrity during TAAA repair, guiding surgical strategies to prevent paraplegia. Selective volume- and pressure controlled perfusion is a technique to continuously perfuse the kidneys during aortic cross clamping and subsequent circulatory exclusion In patients with atherosclerotic thoracoabdominal aortic aneurysms, blood supply to the spinal cord depends on a highly variable collateral system. In our experience, monitoring MEPs allowed detection of cord ischemia, guiding aggressive surgical strategies to restore spinal cord blood supply and reduce neurologic deficit: overall paraplegia rate was less than 3%. We believe that these protective measures should be included in the surgical protocol of TAAA repair, especially in type II cases. Renal and visceral ischemia can be reduced significantly by continuous perfusion during aortic cross clamping in TAAA repair. Not only sufficient volume flow but also adequate arterial pressure appears to be essential in maintaining renal function.Obviously, endovascular modalities have been successfully applied in TAAA patients, the majority of which as part of hybrid procedures. Technological innovation will eventually cause a shift from open to minimal invasive surgical repair. At present, however, open surgery is considered the gold standard for TAAA repair, especially in (relatively) young patients and patients suffering from Marfan's disease.
M J Jacobs; G Mommertz; T A Koeppel; S Langer; R J Nijenhuis; W H Mess; G W H Schurink
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Journal of cardiovascular surgery     Volume:  48     ISSN:  0021-9509     ISO Abbreviation:  J Cardiovasc Surg (Torino)     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-19     Completed Date:  2007-05-24     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0066127     Medline TA:  J Cardiovasc Surg (Torino)     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  49-58     Citation Subset:  IM    
Department of Vascular Surgery, University Hospital, Maastricht, The Netherlands.
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MeSH Terms
Aortic Aneurysm, Abdominal / complications,  surgery*
Aortic Aneurysm, Thoracic / complications,  surgery*
Epidural Space
Heart Bypass, Left / methods
Hypothermia, Induced / methods
Intraoperative Complications / prevention & control
Kidney Failure / etiology,  prevention & control
Paraplegia / etiology,  prevention & control
Postoperative Complications / prevention & control
Risk Factors
Treatment Outcome
Vascular Surgical Procedures / methods*

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

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