Thoracic and thoracoabdominal aortic aneurysm repair: Use of evoked potential monitoring in 118 patients

Dongen, Eric P. van; Schepens, Marc A.A.M.; Morshuis, Wim J.; Beek, Huub T. ter; Aarts, Leon; Boer, Anthonius de; Boezeman, Eduard H.

doi:10.1067/mva.2001.119397

Cited by 89 publications

(34 citation statements)

References 20 publications

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“…Even in such environments, operative mortality is generally in the 10% range, and spinal cord ischemic complications (SCI) remain in the 5% to 15% range. [1][2][3][4][5][6][7][8][9] Indeed, efforts to minimize the risk of SCI have been the principal impetus for the variety of operative strategies and protective adjuncts used during surgery. Clearly, there is no consensus on the major variants of operative approach (e.g., with or without some form of distal aortic perfusion) designed to minimize SCI, as reviewed elsewhere.…”

Section: Discussionmentioning

confidence: 99%

Thoracoabdominal Aneurysm Repair: Results With 337 Operations Performed Over a 15-Year Interval

Cambria¹,

Clouse²,

Davison³

et al. 2002

Annals of Surgery

334

221

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ObjectiveTo review perioperative results and late survival after thoracoabdominal aneurysm repair (TAA), in particular to assess the impact over time of epidural cooling (EC) on spinal cord ischemic complications (SCI). Summary Background DataA variety of operative approaches and protective adjuncts have been used in TAA to minimize the major complications of perioperative death and SCI. There is no consensus with respect to the optimal approach. MethodsFrom January 1987 to November 2001, 337 consecutive TAA repairs were performed by a single surgeon. Clinical features included prior aortic grafts in 97 (28.8%) and emergent operation in 82 (24.6%), including rupture in 46 (13.6%) and dissection in 63 (19%). Operative management consisted of a clamp/sew technique with adjuncts in 93%. EC (since July 1993) to prevent SCI was used in 194 (57.6%) repairs. Variables associated with the end points of operative mortality and postoperative SCI were assessed with the Fisher exact test and logistic regression; late survival was estimated with the Kaplan-Meier method. ResultsOperative mortality was 8.3% and was associated with nonelective operation, intraoperative hypotension, total transfusion requirement, and the postoperative complications of paraplegia, renal failure, and pulmonary insufficiency. Postoperative renal failure and transfusion requirement were independent correlates of mortality. SCI of any severity occurred in 38 of 334 (11.4%) operative survivors, with 22/38 (6.6% of cohort) sustaining total paraplegia. EC reduced the risk of SCI in patients with types I-III TAA (10.6% vs. 19.8%, P ϭ .04). Independent correlates of SCI over the entire study interval included types I/II TAA, rupture, cross-clamp duration, sacrifice of T9 -L1 intercostal vessels, and intraoperative hypotension. Late survival rates at 2 and 5 years were 81.2 Ϯ 3% and 67.2 Ϯ 5%. ConclusionsEC has decreased the risk of SCI after TAA repair. Decreasing the substantial proportion (nearly 25%) of patients requiring nonelective operation will improve results. Late survival is equal to that after routine AAA repair, indicating that the considerable resource expenditure required for TAA repair is worthwhile.Despite advances in endoluminal grafting for isolated thoracic and infrarenal aortic aneurysm, open operation remains the only feasible treatment option for thoracoabdominal aneurysm (TAA). Since TAA extent is relatively uncommon in the spectrum of degenerative aneurysm disease, experience and clinical reports have been largely concentrated in a modest number of centers. Even in such environments, operative mortality is generally in the 10%

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Section: Discussionmentioning

confidence: 99%

Thoracoabdominal Aneurysm Repair: Results With 337 Operations Performed Over a 15-Year Interval

Cambria¹,

Clouse²,

Davison³

et al. 2002

Annals of Surgery

334

221

View full text Add to dashboard Cite

show abstract

“…19,[32][33][34]51,[56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] Only the most recent publication or that containing the largest patient cohort was selected when several publications originated from the same institution.…”

Section: Overview Of the Results Of Recently Published Seriesmentioning

confidence: 99%

Current strategies for spinal cord protection during thoracic and thoracoabdominal aortic aneurysm repair

Shimizu

Yozu

2011

Gen Thorac Cardiovasc Surg

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Surgery for thoracoabdominal aortic aneurysms remains challenging, with high mortality and morbidity rates despite overall improvements in the outcome of aortic surgery. Paraplegia and paraparesis remain devastating complications that severely restrict the chance of survival as well as the postoperative quality of life. Preventive measures vary considerably because the causes of spinal cord insufficiency are multifactorial. Here, we review measures to prevent paraplegia/paraparesis arising after surgery for thoracic and thoracoabdominal aortic aneurysms.

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“…If significant changes in SSEPs, MEPs or EEGs occur, surgical and anesthetic interventions are initiated to attempt to improve spinal cord or brain perfusion. Any improvement in early detection of injury to the sensory or cortical pathway can alert the interpreting neurophysiologist and anesthesiologist of potential reversible injury, who in turn can provide guidance to the surgeon (Galla et al 1999;Guerit et al 1999;de Haan and Kalkman 2001;Wada et al 2001;van Dongen et al 2001;Cheung et al 2002).…”

Section: Other Methods Of Ischemia Detectionmentioning

confidence: 99%

“…Commonly used measures to attempt to detect intraoperative ischemic events and predict adverse neurologic outcome include intraoperative neurophysiologic monitoring of the spinal cord and brain with somatosensory-evoked potentials (SSEPs) (Galla et al 1999;Guerit et al 1999;de Haan and Kalkman 2001;van Dongen et al 2001;Shine et al 2008), motor-evoked potentials (MEPs) (de Haan and Kalkman 2001; Jacobs et al 2006;Kakinohana et al 2007;Kawanishi et al 2007;Shine et al 2008), electrical cortical activity (EEG) (Wada et al 2001;Stecker et al 2001;McGarvey et al 2007;Rijsdijk et al 2009), and the measurement of presumptive biomarkers of ischemia (described below). SSEP measurement, routinely used during TAAA surgery, is widely considered to be safe and potentially beneficial and can be continued until patients have recovered from anesthesia (de Haan and Kalkman 2001; Winnerkvist et al 2007).…”

Section: Other Methods Of Ischemia Detectionmentioning

confidence: 99%

Heat shock proteins as biomarkers for the rapid detection of brain and spinal cord ischemia: a review and comparison to other methods of detection in thoracic aneurysm repair

Hecker

McGarvey

2011

Cell Stress and Chaperones

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The heat shock proteins (HSPs) are members of highly conserved families of molecular chaperones that have multiple roles in vivo. We discuss the HSPs in general, and Hsp70 and Hsp27 in particular, and their rapid induction by severe stress in the context of tissue and organ expression in physiology and disease. We describe the current state of knowledge of the relationship and interactions between extra-and intracellular HSPs and describe mechanisms and significance of extracellular expression of HSPs. We focus on the role of the heat shock proteins as biomarkers of central nervous system (CNS) ischemia and other severe stressors and discuss recent and novel technologies for rapid measurement of proteins in vivo and ex vivo. The HSPs are compared to other proposed small molecule biomarkers for detection of CNS injury and to other methods of detecting brain and spinal cord ischemia in real time. While other biomarkers may be of use in prognosis and in design of appropriate therapies, none appears to be as rapid as the HSPs; therefore, no other measurement appears to be of use in the immediate detection of ongoing severe ischemia with the intention to immediately intervene to reduce the severity or risk of permanent damage.

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Thoracic and thoracoabdominal aortic aneurysm repair: Use of evoked potential monitoring in 118 patients

Abstract: tcMEP monitoring seems to be a useful adjunct of the protective techniques and may cause substantial adjustments in strategy, reducing the incidence of postoperative paraplegia.

Cited by 89 publications

References 20 publications

Thoracoabdominal Aneurysm Repair: Results With 337 Operations Performed Over a 15-Year Interval

Thoracoabdominal Aneurysm Repair: Results With 337 Operations Performed Over a 15-Year Interval

Current strategies for spinal cord protection during thoracic and thoracoabdominal aortic aneurysm repair

Heat shock proteins as biomarkers for the rapid detection of brain and spinal cord ischemia: a review and comparison to other methods of detection in thoracic aneurysm repair

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