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Christian D. Etz
Randall B. Griepp
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J Thorac Cardiovasc Surg 2008;136:796-797
© 2008 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor:

Christian D. Etz, MD, Randall B. Griepp, MD

Mount Sinai School of Medicine, New York, NY

The first 20% of the full text of this article appears below.

We thank Dr Augoustides for his interest and questions.

It seems to us indisputable that ADEQUATE spinal cord perfusion during the first 24 hours postoperatively is critical for the prevention of intermediate delayed paraplegia after thoracic and thoracoabdominal aortic aneurysm repair. Our study made the relatively new observation that a normal blood pressure, if below a patient's preoperative level, can be a risk factor for intermediate delayed paraplegia. This buttresses the argument, which has been made for some time, that higher-than-normal arterial pressures may be necessary for adequate perfusion in the immediate postoperative period for patients after resection of descending thoracic and thoracoabdominal aneurysms to prevent paraplegia because antecedent pressure in many of these patients has been higher than normal. The current observation—linking the required pressure to the patient's presenting blood pressure—now suggests that target arterial pressures during the early postoperative period should be individualized.

Similarly, it has been known for some time that cerebrospinal fluid (CSF) pressure is an important . . . [Full Text of this Article]






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