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Liverpool, United Kingdom

Fok M.,Liverpool John Moores University | Jafarzadeh F.,Thoracic Aortic Aneurysm Service | Sancho E.,Thoracic Aortic Aneurysm Service | Abello D.,Thoracic Aortic Aneurysm Service | And 5 more authors.
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery | Year: 2015

Objective: Paraplegia remains the most feared and a devastating complication after descending and thoracoabdominal aneurysm operative repair (DTA and TAAAR). Neuromonitoring, particularly use of motor-evoked potentials (MEPs), for this surgery has gained popularity. However, ambiguity remains regarding its use and benefit. We systematically reviewed the literature to assess the benefit and applicability of neuromonitoring in DTA and TAAAR. Methods: Electronic searches were performed on 4 major databases from inception until February 2014 to identify relevant studies. Eligibility decisions, method quality, data extraction, and analysis were performed according to predefined clinical criteria and end points. Results: Among the studies matching our inclusion criteria, 1297 patients had MEP monitoring during DTA and TAAAR. In-hospital mortality was low (6.9% ± 3.6). Immediate neurological deficit was low (3.5% ± 2.6). In one third of patients (30.4%T 14.2), theMEPs dropped below threshold, which were 30.4% and 29.4% with threshold levels of 75%and 50%, respectively. A range of surgical techniques were applied after reduction in MEPs. Most patients whose MEPs dropped and remained belowthreshold had immediate permanent neurological deficit (92.0% ± 23.6). Somatosensory-evoked potentials were reported in one third of papers with little association between loss of somatosensoryevoked potentials and permanent neurological deficit (16.7% ± 28.9%). Conclusions: We demonstrate that MEPs are useful at predicting paraplegia in patients who lose their MEPs and do not regain them intraoperatively. To date, there is no consensus regarding the applicability and use of MEPs.Current evidence does not mandate or supportMEPuse. © 2015 by the International Society for Minimally Invasive Cardiothoracic Surgery. Source

Fok M.,Thoracic Aortic Aneurysm Service | Fok M.,Liverpool John Moores University | Bashir M.,Thoracic Aortic Aneurysm Service | Fraser H.,Thoracic Aortic Aneurysm Service | And 2 more authors.
Journal of Medical Systems | Year: 2015

Thoraco-abdominal aneurysms (TAAA) represents a particularly lethal vascular disease that without surgical repair carries a dismal prognosis. However, there is an inherent risk from surgical repair of spinal cord ischaemia that can result in paraplegia. One method of reducing this risk is cerebrospinal fluid (CSF) drainage. We believe that the CSF contains clinically significant biomarkers that can indicate impending spinal cord ischaemia. This work therefore presents a novel measurement method for proteins, namely albumin, as a precursor to further work in this area. The work uses an interdigitated electrode (IDE) sensor and shows that it is capable of detecting various concentrations of albumin (from 0 to 100 g/L) with a high degree of repeatability at 200 MHz (R2 = 0.991) and 4 GHz (R2 = 0.975). © 2015, Springer Science+Business Media New York. Source

Attaran S.,Thoracic Aortic Aneurysm Service | Desmond M.,Thoracic Aortic Aneurysm Service | Field M.,Thoracic Aortic Aneurysm Service | Oo A.,Thoracic Aortic Aneurysm Service
Interactive Cardiovascular and Thoracic Surgery | Year: 2010

Delayed neurological deficit (DND) following thoracic and thoracoabdominal aortic aneurysm repair refers to any neurological deficit in a patient who is evaluated to be neurologically intact postoperatively, but develops neurological problems several hours or days later which can be reversed if identified and treated immediately. We report a rare case where cerebrospinal fluid drainage reversed DND that happened 18 months following type A dissection repair. © 2010 Published by European Association for Cardio-Thoracic Surgery. Source

Fok M.,Thoracic Aortic Aneurysm Service | Bashir M.,Thoracic Aortic Aneurysm Service | Hammoud I.,Thoracic Aortic Aneurysm Service | Harrington D.,Thoracic Aortic Aneurysm Service | And 3 more authors.
Annals of the Royal College of Surgeons of England | Year: 2014

Left ventricular (LV) pseudoaneurysm is a rare entity and, consequently, there is limited knowledge of the condition's natural history. The most frequent mode of presentation for LV pseudoaneurysm is heart failure with chest pain. However, the variable presentation of this condition requires a high index of suspicion for diagnosis. We report the case of a 75-year-old woman who had suffered an acute myocardial infarction 23 years previously, which resulted in a calcified LV apical aneurysm. Three weeks prior to being referred to our hospital, she was noted by her general practitioner to have a left-sided breast mass although mammography was negative. One week later, she attended the accident and emergency department; she was haemodynamically unstable but was resuscitated successfully. Contrast enhanced computed tomography showed a large haematoma located in the left chest wall communicating with the left ventricle. She underwent emergency cardiac surgical repair. On arrival at the intensive care unit following surgery, her haemodynamic status was unstable, and she deteriorated rapidly and died. With this report, we aim to raise the level of awareness for an apical LV pulsatile mass that could anatomically expand and present as a breast mass or tumour. An early diagnosis and timely surgical intervention is essential in order to achieve better outcomes and avoid detrimental complications. Source

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