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Current strategies of spinal cord protection during thoracoabdominal aortic surgery

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Abstract

Despite improved survival rates after thoracoabdominal aortic aneurysm repairs, paraplegia remains a devastating complication with high incidence, ranging from 3 to 10%. Ischemic insults to the spinal cord are unavoidable during thoracoabdominal aortic aneurysm repairs. There is no single measure that can prevent paraplegia alone. A multimodality approach is required to minimize the ischemic insults during thoracoabdominal aortic aneurysm repairs and postoperative second hit to the spinal cord. Distal aortic perfusion is important to maintain the collateral network perfusion pressure, while cerebrospinal drainage allows to directly maintain the spinal cord perfusion. Reattachment of segmental arteries T8–T12 is encouraged to lower the incidence of both immediate and delayed paraplegia. Systemic arterial pressure should be maintained above 130 mmHg and cerebrospinal drainage should be continued until the second postoperative day, despite intact neurological status. In this article, we describe our current operative techniques and perioperative management in patients undergoing repairs of thoracoabdominal aortic aneurysm. A review of recent updates on spinal protection strategies is also reported.

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Authors and Affiliations

  1. Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann Hospital, 6400 Fannin St., Ste. #2850, Houston, TX, USA

    Akiko Tanaka, Hazim J. Safi & Anthony L. Estrera

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  1. Akiko Tanaka
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  2. Hazim J. Safi
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  3. Anthony L. Estrera
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Correspondence to Anthony L. Estrera.

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Dr. Estrera is consultant for WL Gore. The other authors have no disclosures.

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Tanaka, A., Safi, H.J. & Estrera, A.L. Current strategies of spinal cord protection during thoracoabdominal aortic surgery. Gen Thorac Cardiovasc Surg 66, 307–314 (2018). https://doi.org/10.1007/s11748-018-0906-1

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