Spinal Cord Protection for Descending or Thoracoabdominal Aortic Aneurysm Repair

Predictors of paraplegia with current thoracoabdominal aortic aneurysm repair

“…Methods thought to reduce the risk of spinal cord ischemia have been summarized in review papers. 5,6 These include anatomical and pathophysiological understanding of spinal cord blood supply and the scientific basis for clinical interventions used during TAAA repair. Bicknell and colleagues 5 recommended a multimodality approach including revascularization of the intercostals arteries, left heart bypass, spinal cord cooling, CSF drainage, and ensuring mean arterial pressure >80 mm Hg.…”

“…Bicknell and colleagues 5 recommended a multimodality approach including revascularization of the intercostals arteries, left heart bypass, spinal cord cooling, CSF drainage, and ensuring mean arterial pressure >80 mm Hg. Likewise, Nobuyoshi and colleagues 6 described important strategies that reduced the risk of paraplegia, including maintenance of total blood flow to the spinal cord during aortic crossclamping, provision of maximum collateral blood flow, reduction of spinal nervous tissue oxygen demand, prolongation of ischemic tolerance of the spinal cord, and reduction of reperfusion injury.…”

Modified Gott shunt to avoid left ventricular overload and cerebral hypoperfusion during distal aortic arch surgery

“…Spinal cord injury, which remains the most devastating complication despite advances in spinal cord protection, occurs with an incidence ranging between 8% and 28% 3 . Several distal perfusion techniques have been developed to limit this complication, including passive shunt (Gott shunt), left-sided heart bypass, and partial cardiopulmonary bypass,4, 5 all presenting advantages and drawbacks 6 …”