Thorac Cardiovasc Surg 2017; 65(02): 126-129
DOI: 10.1055/s-0036-1579700
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Georg Thieme Verlag KG Stuttgart · New York

A New Combined Technique Reducing the Risk of Paraplegia during Thoracoabdominal Aorta Replacement

Piergiorgio Tozzi
1  Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
,
Etienne Pralong
2  Département de Neurosciences Cliniques, Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
,
Fabrizio Gronchi
3  Departement des Services de Chirurgie et Anesthésiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, VD, Switzerland
,
Giuseppe Siniscalchi
1  Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
› Author Affiliations
Further Information

Publication History

10 December 2015

03 February 2016

Publication Date:
06 April 2016 (online)

Abstract

Acute spinal cord ischemia during thoracoabdominal aorta replacement is a dreadful complication. Existing tools (motor evoked potential [MEP] and somatosensory evoked potential [SSEP]) do not allow differentiating between central and peripheral paraplegia. Therefore, the surgeon often performs unnecessary reimplantation of intercostal arteries: this is time consuming, and significantly increases bleeding complications. We present a simple technique combining MEP and peripheral compound muscle action potential induced by posterior tibialis nerve stimulation, enabling the surgeon to quickly discriminate between central and peripheral neurologic injury. The surgeon has one more tool to drive in real time the optimal surgical strategy. This strategy guides the decision as to which side branches ought to be reimplanted, thus minimizing the risk of paraplegia.