Perioperative Management to Improve Neurologic Outcome in Thoracic or Thoracoabdominal Aortic Stent-Grafting

Ernst Weigang, Marc Hartert, Michael P. Siegenthaler, Nicholas A. Beckmann, Ronen Sircar, G. Szabó, Christian D. Etz, Maximilian Luehr, Patrick von Samson, Friedhelm Beyersdorf

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Background: Thoracic or thoracoabdominal aortic stent-graft repair has shown a reduction in morbidity and mortality rates due to the procedure's advantages (no aortic cross-clamping, continuous distal aortic perfusion, no reperfusion injury). However, 3% to 12% of the patients are at risk of spinal cord ischemia. We investigated spinal cord protective measures with evoked potentials, cerebrospinal fluid drainage, and prevention of hypotension to minimize postoperative neurologic deficit. Methods: Between November 2000 and July 2005, vital parameters and spinal cord function were monitored, including cerebrospinal fluid pressure and transcranial motor-evoked and somatosensory-evoked potentials in 36 stent-graft procedures (31 patients) on the thoracic or thoracoabdominal aorta. Results: Stent-graft placement was technically successful in all patients. We achieved a survival rate of 100% without neurologic deficit after fast-track extubation. Eleven of 31 patients exhibited changes in evoked potentials during stent-graft deployment. In 12 of 31 patients (including the 11 with evoked potential alterations), cerebrospinal fluid pressure exceeded 15 mm Hg. Cerebrospinal fluid drainage and vital parameter adjustment were executed in those instances. We observed intraoperative evoked potential total recovery in 10 of 11 patients after these interventions. Conclusions: Interventions to improve spinal cord perfusion led to total recovery of spinal function in most patients (10/11). Therefore, spinal cord protective measures with motor- and somatosensory-evoked potential monitoring, cerebrospinal fluid drainage, and prevention of hypotension can reduce the incidence of spinal cord ischemia and improve the neurologic outcome of patients undergoing endovascular thoracic or thoracoabdominal aortic repair.

Original languageEnglish
Pages (from-to)1679-1687
Number of pages9
JournalAnnals of Thoracic Surgery
Volume82
Issue number5
DOIs
Publication statusPublished - Nov 2006

Fingerprint

Nervous System
Stents
Thorax
Evoked Potentials
Spinal Cord
Spinal Cord Ischemia
Cerebrospinal Fluid Pressure
Transplants
Somatosensory Evoked Potentials
Neurologic Manifestations
Hypotension
Perfusion
Motor Evoked Potentials
Recovery of Function
Reperfusion Injury
Constriction
Aorta
Survival Rate
Morbidity
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Perioperative Management to Improve Neurologic Outcome in Thoracic or Thoracoabdominal Aortic Stent-Grafting. / Weigang, Ernst; Hartert, Marc; Siegenthaler, Michael P.; Beckmann, Nicholas A.; Sircar, Ronen; Szabó, G.; Etz, Christian D.; Luehr, Maximilian; von Samson, Patrick; Beyersdorf, Friedhelm.

In: Annals of Thoracic Surgery, Vol. 82, No. 5, 11.2006, p. 1679-1687.

Research output: Contribution to journalArticle

Weigang, E, Hartert, M, Siegenthaler, MP, Beckmann, NA, Sircar, R, Szabó, G, Etz, CD, Luehr, M, von Samson, P & Beyersdorf, F 2006, 'Perioperative Management to Improve Neurologic Outcome in Thoracic or Thoracoabdominal Aortic Stent-Grafting', Annals of Thoracic Surgery, vol. 82, no. 5, pp. 1679-1687. https://doi.org/10.1016/j.athoracsur.2006.05.037
Weigang, Ernst ; Hartert, Marc ; Siegenthaler, Michael P. ; Beckmann, Nicholas A. ; Sircar, Ronen ; Szabó, G. ; Etz, Christian D. ; Luehr, Maximilian ; von Samson, Patrick ; Beyersdorf, Friedhelm. / Perioperative Management to Improve Neurologic Outcome in Thoracic or Thoracoabdominal Aortic Stent-Grafting. In: Annals of Thoracic Surgery. 2006 ; Vol. 82, No. 5. pp. 1679-1687.
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AU - Weigang, Ernst

AU - Hartert, Marc

AU - Siegenthaler, Michael P.

AU - Beckmann, Nicholas A.

AU - Sircar, Ronen

AU - Szabó, G.

AU - Etz, Christian D.

AU - Luehr, Maximilian

AU - von Samson, Patrick

AU - Beyersdorf, Friedhelm

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N2 - Background: Thoracic or thoracoabdominal aortic stent-graft repair has shown a reduction in morbidity and mortality rates due to the procedure's advantages (no aortic cross-clamping, continuous distal aortic perfusion, no reperfusion injury). However, 3% to 12% of the patients are at risk of spinal cord ischemia. We investigated spinal cord protective measures with evoked potentials, cerebrospinal fluid drainage, and prevention of hypotension to minimize postoperative neurologic deficit. Methods: Between November 2000 and July 2005, vital parameters and spinal cord function were monitored, including cerebrospinal fluid pressure and transcranial motor-evoked and somatosensory-evoked potentials in 36 stent-graft procedures (31 patients) on the thoracic or thoracoabdominal aorta. Results: Stent-graft placement was technically successful in all patients. We achieved a survival rate of 100% without neurologic deficit after fast-track extubation. Eleven of 31 patients exhibited changes in evoked potentials during stent-graft deployment. In 12 of 31 patients (including the 11 with evoked potential alterations), cerebrospinal fluid pressure exceeded 15 mm Hg. Cerebrospinal fluid drainage and vital parameter adjustment were executed in those instances. We observed intraoperative evoked potential total recovery in 10 of 11 patients after these interventions. Conclusions: Interventions to improve spinal cord perfusion led to total recovery of spinal function in most patients (10/11). Therefore, spinal cord protective measures with motor- and somatosensory-evoked potential monitoring, cerebrospinal fluid drainage, and prevention of hypotension can reduce the incidence of spinal cord ischemia and improve the neurologic outcome of patients undergoing endovascular thoracic or thoracoabdominal aortic repair.

AB - Background: Thoracic or thoracoabdominal aortic stent-graft repair has shown a reduction in morbidity and mortality rates due to the procedure's advantages (no aortic cross-clamping, continuous distal aortic perfusion, no reperfusion injury). However, 3% to 12% of the patients are at risk of spinal cord ischemia. We investigated spinal cord protective measures with evoked potentials, cerebrospinal fluid drainage, and prevention of hypotension to minimize postoperative neurologic deficit. Methods: Between November 2000 and July 2005, vital parameters and spinal cord function were monitored, including cerebrospinal fluid pressure and transcranial motor-evoked and somatosensory-evoked potentials in 36 stent-graft procedures (31 patients) on the thoracic or thoracoabdominal aorta. Results: Stent-graft placement was technically successful in all patients. We achieved a survival rate of 100% without neurologic deficit after fast-track extubation. Eleven of 31 patients exhibited changes in evoked potentials during stent-graft deployment. In 12 of 31 patients (including the 11 with evoked potential alterations), cerebrospinal fluid pressure exceeded 15 mm Hg. Cerebrospinal fluid drainage and vital parameter adjustment were executed in those instances. We observed intraoperative evoked potential total recovery in 10 of 11 patients after these interventions. Conclusions: Interventions to improve spinal cord perfusion led to total recovery of spinal function in most patients (10/11). Therefore, spinal cord protective measures with motor- and somatosensory-evoked potential monitoring, cerebrospinal fluid drainage, and prevention of hypotension can reduce the incidence of spinal cord ischemia and improve the neurologic outcome of patients undergoing endovascular thoracic or thoracoabdominal aortic repair.

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