Mostafa Sadek, Jain B. Pillai, Yonni Pellet, Djamila Abjigitova, Lincoln S. Darla, David Weiss, Konstadinos A. Plestis
Lenox Hill Hospital, New York, NY.
OBJECTIVES: The study was undertaken to evaluate the utilization of Somatosensory Evoked Potential (SSEP) monitoring on Intercostal Artery Reimplantation (IAR) and spinal cord ischemia rates during thoracoabdominal aortic aneurysm (TAAA) repair.
METHODS: Fifty-two patients had TAAA repair with IAR under SSEP guidance (SSEP Group), and 79 patients had repair with routine intercostal artery reimplantation without SSEP guidance (non-SSEP Group) from 1999-2010.
RESULTS: No differences were observed between the SSEP and non SSEP groups in age (63.1 ±11.6 vs. 64.8 ±9.8 years), gender (57.7% vs. 50.6% males), chronic dissections (40.4% vs. 44.3%), renal insufficiency (11.5% vs. 10.1%) and Crawford type 1 and 2 aneurysms (53.9% vs. 53.9%). There was one (1.9%) case of immediate paraplegia and one (1.9%) case of delayed paraplegia in the SSEP group and 2 (2.5%) cases of immediate paraplegia in the non-SSEP group (p=0.92). In the SSEP group, 38 (73.1%) patients had SSEP changes. However, only 15 (28.8%) required reimplantation of intercostals arteries to restore the changes to baseline. In the rest, the changes were restored to baseline by increasing the mean arterial pressure, draining cerebrospinal fluid and optimizing the oxygen delivery to the spinal cord. There were fewer IAR in the SSEP group compared to the non SSEP group (28.8% vs. 59.5%, p=0.004). There was no statistical difference in 30 day mortality between the SSEP and the non-SSEP groups (3.9% vs. 7.6%, p=0.48).
CONCLUSIONS: The utilization of SSEP monitoring led to a significant decrease in the need for IAR without increasing the paraplegia rate.
AUTHOR DISCLOSURES: D. Abjigitova: Nothing to disclose; L. S. Darla: Nothing to disclose; Y. Pellet: Nothing to disclose; J. B. Pillai: Nothing to disclose; K. A. Plestis: Nothing to disclose; M. Sadek: Nothing to disclose; D. Weiss: Nothing to disclose.
Posted April 2013