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SPECIAL ARTICLE  CURRENT TREND IN THORACOABDOMINAL AORTIC ANEURYSM SURGERY - PART 2 Freefree

The Journal of Cardiovascular Surgery 2021 August;62(4):295-301

DOI: 10.23736/S0021-9509.21.11825-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Open thoracoabdominal aortic aneurysm surgery technique: how we do it

Akiko TANAKA, Anthony L. ESTRERA, Hazim J. SAFI

McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA



More than four decades have passed since the modern principals to treat thoracoabdominal aortic aneurysm (TAAA) have been established. The historical challenges in repair of TAAA are represented by - and continue to be - multiorgan protection. Among all organs, the spinal cord remains one of the most vital and vulnerable. We described our current techniques of open extent II TAAA repair, including the following topics: anesthesia, intraoperative monitoring, skin incision, exposure of the TAAA, left heart bypass, graft replacement technique, intercostal artery reattachment, visceral/renal artery reconstructions, and postoperative care. We use cerebrospinal fluid drainage, distal aortic perfusion, mild passive hypothermia, sequential clamping, and visceral and renal perfusion using roller pump in all the cases for multiorgan protection. Both motor-evoked potentials and somatosensory-evoked potentials ere used to guide the conduct of intercostal artery reattachment. Our group demonstrated that the use of adjuncts has reduced the overall spinal cord ischemia rate after Extent I TAAA from 15% to less than 2% and after Extent II TAAA from 33% (50% with clamp time exceeding 40 minutes in “clamp and go” era) to less than 4%. The current standard practice of TAAA repair with adjuncts has improved outcomes, especially regarding spinal cord ischemia.


KEY WORDS: Aortic aneurysm; Surgical procedures, operative; Aortic aneurysm, thoracic

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