Selective intercostal arterial perfusion during thoracoabdominal aortic aneurysm surgery

Background. This clinical study evaluated changes in motor evoked potential s (MEP) elicited by direct cerebral cortical stimulation and evoked spinal cord potentials (ESCPs) elicited by direct spinal cord stimulation during s elective intercostal arterial perfusion for thoracoabdominal aortic aneurys m (TAAA) repair. We also determined the efficacy of this perfusion method f or prevention of paraplegia. Methods. Two kinds of ESCPs and MEPs were monitored during the prosthetic r eplacement step for TAAA surgeries. We performed selective intercostal arte rial perfusion from the T7 intercostal artery to the L1 intercostal artery through a small piece of Dacron graft while monitoring spinal cord potentia ls in five cases of TAAA. Results. The MEP amplitude decreased after clamping the aorta but quickly r ecovered after selective perfusion of intercostal arteries. Other spinal co rd potentials did not change during the reconstruction of intercostal arter ies. Postoperative paraplegia or parapalesis did not occur in any of the pa tients. Conclusions. Monitoring of MEPs during selective intercostal arterial perfu sion was a useful adjunct to prevent postoperative paraplegia in TAAA surge ry. (Ann Thorac Surg 2000;70:44-7) (C) 2000 by The Society of Thoracic Surg eons.