title: Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery†.
abstract: Ischaemic spinal cord injury (SCI) remains the Achilles heel of open and endovascular descending thoracic and thoracoabdominal repair. Neurological outcomes have improved coincidentially with the introduction of neuroprotective measures. However, SCI (paraplegia and paraparesis) remains the most devastating complication. The aim of this position paper is to provide physicians with broad information regarding spinal cord blood supply, to share strategies for shortening intraprocedural spinal cord ischaemia and to increase spinal cord tolerance to transitory ischaemia through detection of ischaemia and augmentation of spinal cord blood perfusion. This study is meant to support physicians caring for patients in need of any kind of thoracic or thoracoabdominal aortic repair in decision-making algorithms in order to understand, prevent or reverse ischaemic SCI. Information has been extracted from focused publications available in the PubMed database, which are cohort studies, experimental research reports, case reports, reviews, short series and meta-analyses. Individual chapters of this position paper were assigned and after delivery harmonized by Christian D. Etz, Ernst Weigang and Martin Czerny. Consequently, further writing assignments were distributed within the group and delivered in August 2014. The final version was submitted to the EJCTS for review in September 2014.
authors.affiliation: Department of Cardiac Surgery, Herzzentrum Leipzig-University Hospital, Germany and Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Etz
authors.affiliation: Department of Vascular and Endovascular Surgery, Evangelisches Krankenhaus St. Hubertus, Berlin, Germany.
authors.forename: Ernst
authors.initials: E
authors.lastname: Weigang
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Mainz, Mainz, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Hartert
authors.affiliation: Department of Vascular Surgery and Cardiovascular Radiology, Faculty of Health Science, Rigshospitalet Copenhagen, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Lonn
authors.affiliation: Department of Cardiovascular Surgery, Hospital Clinic Barcelona, Spain Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Mestres
authors.affiliation: Department of Cardiovascular Surgery, Policlinico Sant'Orsola-Malpighi, Università di Bologna, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.affiliation: Nogent sur Marne, France.
authors.forename: Jean E
authors.initials: JE
authors.lastname: Bachet
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, University Hospital Bern, Bern, Switzerland.
authors.forename: Thierry P
authors.initials: TP
authors.lastname: Carrel
authors.affiliation: Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Grabenwöger
authors.affiliation: Department of Cardiothoracic Surgery, AZ Sant-Jan, Brugge, Belgium.
authors.forename: Marc A A M
authors.initials: MA
authors.lastname: Schepens
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland Department of Cardiovascular Surgery, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany martin.czerny@uniklinik-freiburg.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
mesh_terms: D006801:Humans; D001012:Aorta, Abdominal / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D005060:Europe; D064795:Intraoperative Neurophysiological Monitoring; D017410:Practice Guidelines as Topic; D013116:Spinal Cord / Q000098:blood supply; D020760:Spinal Cord Ischemia / Q000517:prevention & control; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods
keywords: Spinal cord injury; Surgery; TEVAR; Thoracic aorta; Thoracoabdominal aorta