| Protection from postischemic spinal cord injury by perfusion cooling of the epidural space during most or all of a descending thoracic or thoracoabdominal aneurysm repair. | |
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MedLine Citation:
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PMID: 20449713 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: It is reported that hypothermia has some protective effect against ischemia of the spinal cord during thoracoabdominal aneurysm repair. However, it has not been elucidated clinically whether regional spinal cord hypothermia by epidural perfusion cooling is effective and safe. The purpose of this study was to assess the effect and safety of perfusion cooling of the epidural space during most or all of descending thoracic or thoracoabdominal aneurysm repair. METHODS: From January 1998 to December 2007, a total of 102 patients with a mean age of 61 years underwent replacement of most or all of the descending thoracic aorta or thoracoabdominal aorta with the aid of mild hypothermia via epidural perfusion cooling and cerebrospinal fluid (CSF) drainage. Risk factors for spinal cord injury and hospital death were analyzed using univariate and multivariate analyses. The actuarial survival rate was calculated by the Kaplan-Meier method. RESULTS: The mean lowest CSF temperature was 23.3 degrees C during epidural perfusion cooling. The mean temperature difference between the nasopharynx and CSF was 8.4 degrees C. The incidence of spinal cord injury was 3.9% (4/102), and that of hospital death was 5.9% (6/102). There was no significant risk factor associated with spinal cord injury. Type III aneurysm and postoperative cerebrovascular accident, respiratory failure, liver failure, and infection were predictors of hospital death. The actuarial survival rates at 3 and 5 years were 82.1% and 75.9%, respectively. CONCLUSION: Epidural perfusion cooling is a safe method to employ in clinical situations. Our contemporary management strategies enabled patients to undergo thoracoabdominal aneurysm repair with excellent early and late survival and acceptable morbidity. |
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Authors:
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Koichi Tabayashi; Yoshikatsu Saiki; Hiroaki Kokubo; Goro Takahashi; Junetsu Akasaka; Seijirou Yoshida; Masaki Hata; Koki Niibori; Makoto Miura; Toshiaki Konnai |
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Publication Detail:
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Type: Journal Article Date: 2010-05-07 |
Journal Detail:
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Title: General thoracic and cardiovascular surgery Volume: 58 ISSN: 1863-6713 ISO Abbreviation: Gen Thorac Cardiovasc Surg Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-07 Completed Date: 2010-08-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101303952 Medline TA: Gen Thorac Cardiovasc Surg Country: Japan |
Other Details:
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Languages: eng Pagination: 228-34 Citation Subset: IM |
Affiliation:
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Department of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan. ktaba@mail.tains.tohoku.ac.jp |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Aortic Aneurysm, Thoracic / mortality, surgery* Blood Vessel Prosthesis Implantation / adverse effects*, mortality Epidural Space Female Hospital Mortality Humans Hypothermia, Induced / adverse effects, methods*, mortality Kaplan-Meiers Estimate Logistic Models Male Middle Aged Perfusion* / adverse effects, mortality Risk Assessment Risk Factors Spinal Cord Ischemia / etiology, mortality, prevention & control* Time Factors Treatment Outcome Young Adult |
| Comments/Corrections | |
Comment In:
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Gen Thorac Cardiovasc Surg. 2010 May;58(5):220-2
[PMID:
20449711
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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