The Annals of thoracic surgery
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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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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.
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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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Comment Case Reports
Witnessing death as lifesaving treatment is withheld.
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The appropriate surgical strategy for patients with an arch tear in acute type A dissection remains controversial. We retrospectively compared surgical results after hemiarch as compared with transverse aortic arch replacement in patients with an arch tear in acute type A dissection. ⋯ Hemiarch replacement for acute type A dissection demonstrated favorable early and late outcome. The extent of graft replacement influenced surgical mortality and morbidity. Whenever the intimal tear is located in the lesser curvature of the transverse arch, hemiarch replacement is recommended to improve overall operative mortality and morbidity.