Current Approaches to Spinal Cord Protection During Open Thoracoabdominal Aortic Aneurysm Repair

Authors

Joseph S Coselli
Scott A LeMaire
Vicente Orozco-Sevilla
Ourania Preventza
Marc R Moon
Lauren M Barron
Subhasis Chatterjee

Publication Date

9-28-2023

Journal

Annals of Cardiothoracic Surgery

DOI

10.21037/acs-2023-scp-10

PMID

37817849

PMCID

PMC10561332

PubMedCentral® Posted Date

5-4-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Spinal cord, aortic aneurysm, thoracoabdominal, perioperative care

Abstract

Spinal cord deficit (SCD) is a feared complication after thoracoabdominal aortic aneurysm repair. Vigilant management throughout the perioperative period is necessary to reduce the risk of SCD. Measures for preventing SCD during the intraoperative period include preoperative optimization and recognizing patients at a higher risk of SCD. In this manuscript, we discuss intraoperative adjuncts including utilization of cerebrospinal fluid drainage, left heart bypass, mild hypothermia, selective reimplantation of intercostal and lumbar arteries, and renal and visceral vessel perfusion. From the operative to the postoperative period, careful attention to avoiding hypotension and anemia is important. If SCD is recognized early, therapeutic intervention may be implemented to mitigate injury.