What is included in postoperative care for thoracic aortic aneurysm (TAA)?

Updated: Apr 02, 2021
  • Author: Elaine Tseng, MD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Patients who have undergone ascending aneurysm repairs are observed for signs of coronary ischemia, particularly if the coronary ostia were reimplanted, and for signs of aortic insufficiency when the aortic valve is repaired. After repair of arch aneurysms, particular attention must be given to neurologic status, and patients who have had the elephant trunk repair must be observed for signs of paraplegia because the telescoped sleeve in the descending aorta may obstruct critical spinal vessels.

Paraplegia is the main concern in patients who have had repair of the descending and thoracoabdominal aorta. CSF drainage may be continued for up to 72 hours postoperatively if necessary, along with motor evoked potential monitoring. Paraplegia and paraparesis may be acute or delayed postoperatively. If they are delayed, increased mean arterial pressure with pressors and reinstitution of CSF drainage may augment spinal cord perfusion to reverse this complication. Paraplegia due to occlusion of critical spinal arteries that were not reimplanted cannot be reversed by these maneuvers.

Acute postoperative renal dysfunction may be due to extended periods of ischemic cross-clamping or to hypothermic circulatory arrest.

Patients undergoing endovascular stenting are often extubated early postoperatively with a decreased length of stay in the intensive care unit (ICU).

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