Practice of neuromonitoring in open and endovascular thoracoabdominal aortic repair—an international expert-based modified Delphi consensus study
Author:
Schachner Thomas1ORCID, Gottardi Roman23ORCID, Schmidli Jürg4ORCID, Wyss Thomas R45, Van Den Berg Jos C6ORCID, Tsilimparis Nikolaos7ORCID, Bavaria Joseph8, Bertoglio Luca9ORCID, Martens Andreas10ORCID, Czerny Martin23ORCID, Preventza Ourania, Matsuda Hitoshi, Jacobs Michael, Reutersberg Benedikt, Chiesa Roberto, Probst Chris, Piffaretti Gabriele, Di Eusanio Marco, Sorokin Vitaly, Verzini Fabio, Szeberin Zoltan, Cheng Stephen Wk, Di Marco Luca, Gosslau Yvonne, Matalanis George, Tsagakis Konstantinos, Oderich Gustavo, Jakobsen Øyvind, Oo Aung, Koshty Ahmed, Pichlmaier Maximilian, Kolowca Maciej, Heijmen Robin H, Mendes Pedro Luís, Fourneau Inge, Zimmermann Alexander, Minatoya Kenji, Haulon Stephan, Luehr Maximilian, Reeps Christian, Sioris Thanos, Nienaber Christoph, Trimarchi Santi, Elefteriades John A, Weigang Ernst, Kuratani Toru, Meisenbacher Katrin, Jassar Arminder, Grabenwoeger Martin, D’Oria Mario, Fink Martina, van Herwaarden Joost, Rosati Fabrizio, Verhoeven Eric, Szopiński Piotr, Lescan Mario, Assadian Afshin, Okita Yutaka, Park Kay-Hyun, Marrocco-Trischitta Massimiliano,
Affiliation:
1. University Clinic of Cardiac Surgery and University Clinic of Vascular Surgery, Innsbruck Medical University , Innsbruck, Austria 2. Department of Cardiovascular Surgery, University Heart Center Freiburg–Bad Krozingen , Germany 3. Faculty of Medicine, Albert Ludwigs University Freiburg , Friberg, Germany 4. Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern , Bern, Switzerland 5. Kantonsspital Winterthur, Department of Interventional Radiology and Vascular Surgery , Winterthur, Switzerland 6. Centro Vascolare Ticino, Ospedale Regionale di Lugano, sede Civico Inselspital, Universitätsspital Bern Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie, Switzerland 7. Department of Vascular Surgery, Ludwig Maximilian University Hospital , Munich, Germany 8. Department of Cardiovascular Surgery, University of Pennsylvania , Philadelphia, PA, USA 9. Division of Vascular Surgery, Vita Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Milano , Italy 10. Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School , Hannover, Germany
Abstract
Abstract
OBJECTIVES
Spinal cord injury is detrimental for patients undergoing open or endovascular thoracoabdominal aortic aneurysm (TAAA) repair. The aim of this survey and of the modified Delphi consensus was to gather information on current practices and standards in neuroprotection in patients undergoing open and endovascular TAAA.
METHODS
The Aortic Association conducted an international online survey on neuromonitoring in open and endovascular TAAA repair. In a first round an expert panel put together a survey on different aspects of neuromonitoring. Based on the answers from the first round of the survey, 18 Delphi consensus questions were formulated.
RESULTS
A total of 56 physicians completed the survey. Of these, 45 perform open and endovascular TAAA repair, 3 do open TAAA repair and 8 do endovascular TAAA repair. At least 1 neuromonitoring or protection modality is utilized during open TAAA surgery. Cerebrospinal fluid (CSF) drainage was used in 97.9%, near infrared spectroscopy in 70.8% and motor evoked potentials or somatosensory evoked potentials in 60.4%. Three of 53 centres do not utilize any form of neuromonitoring or protection during endovascular TAAA repair: 92.5% use CSF drainage; 35.8%, cerebral or paravertebral near infrared spectroscopy; and 24.5% motor evoked potentials or somatosensory evoked potentials. The utilization of CSF drainage and neuromonitoring varies depending on the extent of the TAAA repair.
CONCLUSIONS
The results of this survey and of the Delphi consensus show that there is broad consensus on the importance of protecting the spinal cord to avoid spinal cord injury in patients undergoing open TAAA repair. Those measures are less frequently utilized in patients undergoing endovascular TAAA repair but should be considered, especially in patients who require extensive coverage of the thoracoabdominal aorta.
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,General Medicine,Surgery
Cited by
1 articles.
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