Can intraoperative motor-evoked potentials predict all the spinal cord ischemia during moderate hypothermic beating heart descending thoracic or thoraco-abdominal aortic surgery?

Journal of Cardiac Surgery
Ho-Ki MinByung-Joon Park

Abstract

Paraplegia is a serious complication of descending thoracic or thoraco-abdominal aortic aneurysm (DTAA or TAAA, respectively) surgery. The functional integrity of the spinal cord can be monitored with intraoperative motor-evoked potentials (MEPs). Herein, we evaluated the results and adequacy of MEP monitoring. Between March 2006 and April 2009, 33 patients (24 males and 9 females) were monitored with MEPs and reviewed retrospectively. The mean age was 50.7 ± 15.2 years. Eighteen and 15 patients underwent TAAA and DTAA repairs, respectively. We routinely used femoro-femoral partial bypass and cerebrospinal fluid (CSF) drainage. If the MEP demonstrated a significant change, prompt protective interventions were performed. During the procedure, 31 patients (93.9%) had a detectable MEP, of whom four had significant MEP changes and only one had an accompanying alteration in the somatosensory-evoked potential. In-hospital mortality occurred in two patients (6.0%) because of mesenteric ischemia and sepsis, respectively. Postoperative paraplegia developed in two patients (6.0%), one with an undetectable MEP and another with no significant intraoperative MEP change. Both patients had hypotensive events and impaired CSF drainage in the i...Continue Reading

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Citations

May 20, 2014·The Journal of Thoracic and Cardiovascular Surgery·Yukihiro HayatsuYoshikatsu Saiki
Sep 3, 2014·Asian Cardiovascular & Thoracic Annals·Nirmal Panthee, Minoru Ono
Nov 5, 2015·Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery·Matthew FokMohamad Bashir
Feb 15, 2011·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Harvey L Edmonds, Scott A LeMaire
Aug 10, 2019·Neural Regeneration Research·Paul A LapchakAli Khoynezhad

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