• Christian D Etz, Ernst Weigang, Marc Hartert, Lars Lonn, Carlos A Mestres, Roberto Di Bartolomeo, Jean E Bachet, Thierry P Carrel, Martin Grabenwöger, Marc A A M Schepens, and Martin Czerny.
• Department of Cardiac Surgery, Herzzentrum Leipzig-University Hospital, Germany and Mount Sinai School of Medicine, New York, NY, USA.
• Eur J Cardiothorac Surg. 2015 Jun 1; 47 (6): 943-57.

AbstractIschaemic spinal cord injury (SCI) remains the Achilles heel of open and endovascular descending thoracic and thoracoabdominal repair. Neurological outcomes have improved coincidentially with the introduction of neuroprotective measures. However, SCI (paraplegia and paraparesis) remains the most devastating complication. The aim of this position paper is to provide physicians with broad information regarding spinal cord blood supply, to share strategies for shortening intraprocedural spinal cord ischaemia and to increase spinal cord tolerance to transitory ischaemia through detection of ischaemia and augmentation of spinal cord blood perfusion. This study is meant to support physicians caring for patients in need of any kind of thoracic or thoracoabdominal aortic repair in decision-making algorithms in order to understand, prevent or reverse ischaemic SCI. Information has been extracted from focused publications available in the PubMed database, which are cohort studies, experimental research reports, case reports, reviews, short series and meta-analyses. Individual chapters of this position paper were assigned and after delivery harmonized by Christian D. Etz, Ernst Weigang and Martin Czerny. Consequently, further writing assignments were distributed within the group and delivered in August 2014. The final version was submitted to the EJCTS for review in September 2014. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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