The Annals of thoracic surgery
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Surgeons are increasingly faced with patients suffering from complicated pathology in multiple organ systems, to which multiple therapeutic agents with complex adverse effects are often prescribed. We face a daily challenge in maintaining an up-to-date knowledge of these complications. ⋯ This is a rare but serious complication of heparin therapy, not usually reported in the context of a cardiac surgical patient. We will also discuss the renal physiology leading to hyperkalemia and the options available for its management.
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Herein are described recent developments in aortic surgery techniques and the improved results. ⋯ Minimally invasive surgery is particularly useful for reoperations. The blood conservation methods appear to be beneficial and the number of neurologic deficits is low with the current protocol.
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Comparative Study
Intraoperative spinal cord monitoring during descending thoracic and thoracoabdominal aneurysm surgery.
Postoperative paraplegia is one of the most dreaded complications after descending thoracic and thoracoabdominal aneurysm surgery. In this study, intraoperative monitoring was applied during resection of descending thoracic and thoracoabdominal aneurysms to detect spinal cord ischemia and help prevent paraplegia. ⋯ The results demonstrate that compared with SSEP, MEP, especially myogenic MEP, is more sensitive and specific in detection of spinal cord ischemia, and that intraoperative monitoring can indeed help prevent paraplegia.
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Monitoring motor-evoked potentials (MEPs) is an accurate technique to assess spinal cord integrity during thoracoabdominal aortic aneurysm (TAAA) repair, guiding surgical strategies to prevent paraplegia. ⋯ In patients with TAAA, blood supply to the spinal cord depends upon a highly variable collateral system. Monitoring MEPs is an accurate technique for detecting cord ischemia, guiding surgical tactics to reduce neurologic deficit (2.4%).
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Comparative Study
Stent grafts for the thoracic aorta: a new paradigm?
The treatment of thoracic aortic pathology is complicated by the morbidity of the surgical procedure, and the comorbidities encountered in an elderly population. Stent grafts have now been used for approximately 10 years for the treatment of thoracic aneurysmal disease, management of aortic dissections, intramural hematoma, and giant penetrating ulcers, and for traumatic aortic tears, with impressive early results. ⋯ Nevertheless, significant and even unique therapies have been enabled by stent graft technology for the treatment of the above-mentioned diseases. It is likely that, with more sophisticated technology and improved understanding of thoracic aortic pathology, stent graft use will expand, and its utility will be further clarified.