Cardiology clinics
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Thoracoabdominal aortic aneurysms (TAAAs) have a dismal natural history that frequently necessitates surgical repair, but such repairs sometimes result in paraplegia and paraparesis. To reduce the risk of these complications, intraoperative monitoring of spinal cord motor evoked potentials (MEPs) can be used to guide TAAA repair procedures and may potentially minimize spinal cord ischemia. However, the use of MEP monitoring techniques requires important changes to anesthetic management, entails certain risks, and has important contraindications.
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Straight deep hypothermic circulatory arrest (DHCA) is a technique available for brain preservation during deep hypothermic arrest in aortic arch replacement. In this article, the author discusses the practice of straight DHCA in his institute and the advantage of this technique over other brain preservation techniques.
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Paraplegia is one of the most severe complications of the repair of open descending thoracic aortic aneurysms and thoracoabdominal aortic aneurysms. To reduce these complications, a comprehensive strategy for spinal cord protection is mandatory. Motor evoked potentials provide the surgeon with important information about spinal cord integrity throughout the operation. Neuroprotective measures include extracorporeal circulation, cerebrospinal fluid drainage, hypothermia, and selective segmental artery revascularization.
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The technical simplicity of retrograde cerebral perfusion (RCP) together with a highly favorable effect upon stroke rates and survival after aortic arch surgery justifies continued clinical use of RCP in patients requiring hypothermic circulatory arrest (HCA), in particular patients with dissecting or atheromatous arch branches. In clinical practice, using RCP can provide effective brain protection in HCA for about 40 to 60 minutes, although there is a time limitation.