Keywords: achalasia; analgesia; aortic aneurysm; aortic regurgitation; cardiopulmonary bypass; cerebrospinal fluid damage; coagulopathy; deep hypothermic circulatory arrest; descending thoracic aorta; diaphragm; ketamine; left ventricle; multidisciplinary approach; paraparesis; paraplegia; patrial thromboplastin time; renal dysfuction; spinal cord ischemia; spinal cord perfusion pressure; steroids; thoracoabdominal aorta; thoracotomy; transesophageal echocardiograpy.