Möglichkeiten des grenzüberschreitenden Telemonitorings bei Ersatzoperationen des thorakoabdominalen Aortenaneurysmas

Greiner, A; Mess, WH; Schmidli, J; Dick, F; Grommes, J; Jacobs, M (2010). Möglichkeiten des grenzüberschreitenden Telemonitorings bei Ersatzoperationen des thorakoabdominalen Aortenaneurysmas. Gefässchirurgie, 15(5), pp. 311-316. Berlin: Springer-Medizin-Verlag 10.1007/s00772-010-0785-y

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Open aneurysm repair of the thoracoabdominal and thoracic descending aorta is associated with a manifest risk for neurological complications. Particularly neuromonitoring of the spinal function by means of motor-evoked potentials (MEPs) is a valid method for surveillance and to reveal an insufficient arterial supply at an early point in time. However, the use of MEPs requires not only a complex technical infrastructure but also a high level of expertise.

We demonstrate how three vascular centers in three countries resort to one technical infrastructure and neuromonitoring expertise during complex aortic surgery by using telemedicine. Our experience is based on 59 patients treated by open surgery in Bern (Inselspital) and Aachen (University hospital) for aneurysms of the descending thoracic aorta (TAA) and the thoracoabdominal aorta (TAAA), respectively. In all patients the protective and surgical strategies to prevent paraplegia were guided by online assessment of MEPs. The measured neuromonitoring data were evaluated by a centralized team of neurophysiologists in Maastricht. In 33 patients a significant drop in MEPs was recorded requiring immediate protective and surgical arrangements. In 9 patients, blood pressure management or the reposition of the cross clamping was sufficient. All other cases required reattachment of arteries supplying the spinal cord. In all 33 patients the protective and surgical strategies were successful so that no paraplegia occurred immediately postoperation. The clinical results were in accordance with the intraoperative MEPs. In all cases the data communication was stabile and enabled the successful evaluation of the time course of MEPs. Neuromonitoring in TAAA and TAA surgery is suitable for telemedical use across national boundaries.

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