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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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ORIGINAL ARTICLES  NEW FRONTIERS IN THORACIC AND THORACOABDOMINAL AORTIC REPAIR


The Journal of Cardiovascular Surgery 2015 October;56(5):745-49

Copyright © 2015 EDIZIONI MINERVA MEDICA

lingua: Inglese

Spinal cord protection in open- and endovascular thoracoabdominal aortic aneurysm repair: critical review of current concepts and future perspectives

Von Aspern K., Luehr M., Mohr F. W., Etz C. D.

Department of Cardiac Surgery, University Heart Center Leipzig, Leipzig, Germany


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Unresolved for over half a century now since the beginning of aortic surgery spinal cord injury (SCI) remains the most devastating complication after extensive open and endovascular thoracoabdominal aortic aneurysm (TAA/A) repair. Over the past decade extensive research on spinal cord perfusion lead to a better understanding of previously unknown physiologic mechanisms involved in the suspension of the cord’s arterial supply and the consecutive development of SCI underscoring the need for new concepts in treatment strategy and monitoring methods during and after TAA/A repair. Based on this knowledge, new treatment strategies in particular the staged-repair were developed. The first-in-man translation of this idea has just been published introducing the new concept: minimally invasive selective segmental artery coil-embolization. Another approach to overcome the most critical initial period after segmental artery occlusion due to stent graft deployment in the descending or thoracoabdominal aorta is temporary aneurysm sac perfusion, which also has recently been clinically trialed. Furthermore, the new non-invasive real-time monitoring method to record spinal cord viability by means of near-infrared spectroscopy of the paraspinal collateral network by means of near-infrared spectroscopy has also been suggested and successfully introduced in a pilot series to a clinical setting. This review addresses problems, unsolved questions and future perspectives regarding these three new concepts.

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Konstantin.Aspern@Helios-Kliniken.de