INTRAOPERATIVE NEUROMONITORING: ADVANCING PRECISION AND NEUROPROTECTION IN CARDIOTHORACIC SURGERY juliopaza98@gmail.com

462-03

INTRAOPERATIVE NEUROMONITORING: ADVANCING PRECISION AND NEUROPROTECTION IN CARDIOTHORACIC SURGERY

6

United Kingdom

Oral or Poster

Intraoperative neuromonitoring (IONM), a cornerstone of neurosurgery, is emerging as a vital tool in cardiothoracic surgery for mitigating neurological risks in procedures like aortic arch repair and coronary artery bypass grafting (CABG). This narrative review explores IONM’s underutilized potential to enhance patient safety by detecting stroke and neurological complications.

Literature from 2018–2024 was reviewed, including STS National Database studies, Annals of Thoracic Surgery, and Journal of Cardiothoracic and Vascular Anesthesia. Focus areas included IONM applications (somatosensory evoked potentials [SSEP] and electroencephalography [EEG]) in thoracic aortic surgery and CABG. Outcomes assessed were stroke incidence, neurological deficit rates, and intraoperative interventions. Data were sourced from peer-reviewed journals and AATS/STS proceedings.

A 2023 study reported significant IONM changes (EEG/SSEP) in aortic arch surgery predicted adverse neurological outcomes (10.9% vs. 2.9%, p=0.008), enabling real-time interventions like perfusion adjustments (Annals of Thoracic Surgery). In CABG, IONM detected cerebral ischemia in 23.7% of non-stroke cases, with permanent EEG changes linked to higher stroke risk (18.2% vs. 5.3%, p=0.006). Only 3.1% of 19,299 coronary/valve surgeries (2010–2021) used IONM, reflecting barriers like cost and lack of standardized protocols (Open Heart, 2024). Interdisciplinary collaboration with neurosurgery enhances outcomes but is limited.

IONM offers transformative potential in cardiothoracic surgery, enabling early detection and mitigation of neurological risks. Limited adoption and protocol variability hinder its impact. Future directions include cardiothoracic-specific IONM guidelines and AI-enhanced monitoring, bridging neurosurgery and cardiothoracic practice for safer surgeries.