Practice of Neuromonitoring in open and endovascular thoracoabdominal aortic repair - An international expert-based modified Delphi consensus Study.

Schachner, Thomas; Gottardi, Roman; Schmidli, Jürg; Wyss, Thomas R; Van den Berg, Jos C; Tsilimparis, Nikolaos; Bavaria, Joseph; Bertoglio, Luca; Martens, Andreas; Czerny, Martin (2023). Practice of Neuromonitoring in open and endovascular thoracoabdominal aortic repair - An international expert-based modified Delphi consensus Study. European journal of cardio-thoracic surgery, 63(6) Oxford University Press 10.1093/ejcts/ezad198

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BACKGROUND

Spinal cord injury (SCI) is detrimental for patients undergoing open or endovascular thoracoabdominal aortic (TAAA) repair. Aim of this survey and modified Delphi consensus was to gather information on current practice 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 a survey on different aspects of neuromonitoring together. Based on the answers from the first round of the survey, 18 Delphi consensus questions were formulated.

RESULTS

56 physicians completed the survey. 45 perform open and endovascular TAAA repair, 3 open TAAA repair and 8 endovascular TAAA repair. At least one neuromonitoring or protection modality is utilized during open TAAA surgery. Cerebrospinal fluid (CSF) drainage was used 97.9%, Near Infrared spectroscopy (NIRS) in 70.8%, and motor evoked potentials or somatosensory evoked potentials (SEP) 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 NIRS and 24.5% MEPs or SEPs. The utilization of CSF drainage and neuromonitoring varies depending on the extent of TAAA repair.

CONCLUSION

The results of this survey and Delphi consensus show that there is broad consensus on the importance to protect the spinal cord to avoid SCI 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 that require extensive coverage of the thoracoabdominal aorta.

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