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The Journal of Cardiovascular Surgery 2021 Jan 26

DOI: 10.23736/S0021-9509.21.11783-5

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Spinal cord protection in thoracoabdominal aortic aneurysm surgery: a multimodal approach

Josephina HAUNSCHILD 1 ,Konstantin von ASPERN 1, Martin MISFELD 1, 2, 3, Piroze DAVIERWALA 1, Michael A. BORGER 1, Christian D. ETZ 1

1 University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; 2 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; 3 The Discipline of Medicine, The Central Clinical School, The Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia


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Spinal cord injury is one major complication of open and endovascular thoracic and thoracacoabdominal aortic aneurysm repair. Despite numerous neuroprotective adjuncts, the incidence of SCI remains high. This review article discusses established and novel adjuncts for spinal cord protection, including priming and preconditioning of the paraspinal collateral network, intraoperative systemic hypothermia, distal aortic perfusion, motor- and somatosensory evoked potentials and non-invasive cnNIRS monitoring as well as peri- and postoperative drainage of cerebrospinal fluid. Regardless of the positive influence of many of these strategies on neurologic outcome, to date no strategy assures definitive preservation of spinal cord integrity during and after aortic aneurysm repair.


KEY WORDS: Aortic aneurysm; Spinal cord ischemia; Paraplegia

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