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The Journal of Cardiovascular Surgery 2020 Dec 14

DOI: 10.23736/S0021-9509.20.11712-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Critical care management after open thoracoabdominal aortic aneurysm repair

Subhasis CHATTERJEE 1, 2 , Ourania PREVENTZA 2, 3, 4, Vicente OROZCO-SEVILLA 2, 3, 4, Joseph S. COSELLI 2, 3, 4

1 Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; 2 Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; 3 Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA; 4 Department of Cardiovascular Surgery, CHI St Luke’s Health-Baylor St Luke’s Medical Center, Houston, TX, USA


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Thoracoabdominal aortic aneurysm repair is technically demanding for the surgeon and physiologically demanding on the patient. As such, it requires diligent multidisciplinary perioperative care to maximize the likelihood of a successful outcome. In this article, we discuss key principles for managing patients after open thoracoabdominal aortic aneurysm repair, which we have learned over the course of performing more than 3500 of such procedures. These principles address patient handoff between the operating room and intensive care unit, resuscitation, prevention and management of spinal cord deficits, and important neurological, respiratory, cardiovascular, renal, gastrointestinal, and hematological considerations. Understanding the expected postoperative course allows for earlier recognition of deviations from that course and increases the likelihood of successful rescue of patients from adverse outcomes. Achieving positive outcomes after thoracoabdominal aortic aneurysm repair requires attention to detail across the perioperative, intraoperative, and postoperative phases of care.


KEY WORDS: Aortic aneurism, abdominal; Aortic aneurism, thoracic; Spinal cord injuries; Perioperative care

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