Neuromonitor-guided repair of thoracoabdominal aortic aneurysms

• Published in: Journal of thoracic and cardiovascular surgery (Print) Vol. 140; no. 6; pp. S131 - S135
• Main Authors: Estrera, Anthony L., MD, Sheinbaum, Roy, MD, Miller, Charles C., PhD, Harrison, Ryan, BA, Safi, Hazim J., MD
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Mosby, Inc 01.12.2010; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - physiopathology; Aortic Aneurysm, Thoracic - surgery; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiothoracic Surgery; Cerebrospinal Fluid Shunts - adverse effects; Diseases of the aorta; Evoked Potentials, Motor; Evoked Potentials, Somatosensory; Female; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative - methods; Pneumology; Predictive Value of Tests; Replantation; Retrospective Studies; Spinal Cord Ischemia - diagnosis; Spinal Cord Ischemia - etiology; Spinal Cord Ischemia - physiopathology; Spinal Cord Ischemia - prevention & control; Texas; Thoracic Arteries - surgery; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality; Young Adult; Texas; 38; ICA; 19; somatosensory evoked potential; TAAA; SSEP; 1; CSFD; thoracic endovascular aortic repair; DAP; motor evoked potential; TEVAR; CSF; cerebrospinal fluid; intercostal artery; MEP; thoracoabdominal aortic aneurysm; distal aortic perfusion; cerebrospinal fluid drainage; Corrective surgery; Treatment; Cardiovascular disease; Anesthesia; Circulatory system; Cardiology; Repair; Thoracoabdominal; Aortic aneurysm
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2010.07.058

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.