Ali Shahriari, James Williams
The Indiana Heart Hospital, Indianapolis, IN.
OBJECTIVES: To review the benefits of motor-evoked potential (MEP) monitoring in reducing the risk of spinal cord injury (SCI) during thoracic endovascular aortic repair (TEVAR).
METHODS: We performed a retrospective study using a prospective database of all patients undergoing elective TEVAR at our institution. All patients underwent intraoperative MEP monitoring. The incidence of SCI and the benefit of using intraoperative MEP’s was analyzed.
RESULTS: Between December 2008 and December 2011, 105 elective TEVARs were performed in our institution. All procedures were performed under general anesthesia with intraoperative MEP monitoring. Sixty-two (59%) patients underwent concomitant performance of left carotid-subclavian bypass. Intraoperative MEPs showed a significant change in 6 cases (5.7%), all of which recovered with hemodynamic management and in 2 cases (1.9%) by using a CSF drain. There were no instances of paraplegia or paralysis. One patient (0.9%) had a type I endoleak and 6 (5.7%) had a type II endoleak. The 30-day mortality for this cohort was zero.
CONCLUSIONS: Utilization of MEPs changed the management in 5.7% of our patients and was instrumental in preventing SCI in these patients. Using MEPs has allowed us to use CSF drains on a selective basis rather than routine. MEP monitoring is an inexpensive modality that may help reduce significant morbidity and long-term mortality for this patient population.
AUTHOR DISCLOSURES: A. Shahriari, Nothing to disclose; J. Williams, Nothing to disclose.
Posted April 2012