| Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented? | |
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MedLine Citation:
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PMID: 17293121 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Understanding the ability of the paraspinal anastomotic network to provide adequate spinal cord perfusion pressure (SCPP) critical for both surgical and endovascular repair of thoracoabdominal aortic aneurysms (TAAA). METHODS: To monitor pressure in the collateral circulation, a catheter was inserted into the distal end of the divided first lumbar segmental artery (SA) of 10 juvenile Yorkshire pigs (28.9+/-3.8kg). SA pairs from T3 through L5 were serially sacrificed at 32 degrees C; SCPP and function - using motor-evoked potentials (MEPs) - were continuously monitored until 1h after clamping the last SA. Intermittent aortic and SCPP monitoring was continued for 5 days postoperatively, along with evaluation of motor function. RESULTS: A mean of 14.4+/-0.7 SAs were sacrificed without loss of MEP. SCPP (mmHg) dropped from 68+/-7 before SA clamping (77% of aortic pressure) to 22+/-6 at end clamping, and 21+/-4 after 1h, reaching its lowest point - 19+/-4 - after 5h. Postoperatively, SCPP recovered to 33+/-6 at 24h; 42+/-10 at 48h; 56+/-14 at 72h; 62+/-15 at 96h, returning to baseline (63+/-20) at 120h. Despite comparable SCPP patterns, four pigs did not fully regain the ability to stand. Six animals recovered: two could stand and four could walk. CONCLUSIONS: Interruption of all SAs at 32 degrees C in this pig model results in a spectrum of cord injury, with normal function in a majority of pigs postoperatively. The short duration of low SCPP suggests that hemodynamic manipulation lasting only 24-48h may allow routine complete preservation of normal cord function despite sacrifice of all SAs. |
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Authors:
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Christian D Etz; Tobias M Homann; Konstadinos A Plestis; Ning Zhang; Maximilian Luehr; Donald J Weisz; George Kleinman; Randall B Griepp |
Publication Detail:
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Type: Journal Article Date: 2007-02-12 |
Journal Detail:
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Title: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Volume: 31 ISSN: 1010-7940 ISO Abbreviation: Eur J Cardiothorac Surg Publication Date: 2007 Apr |
Date Detail:
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Created Date: 2007-03-19 Completed Date: 2007-06-28 Revised Date: 2011-09-22 |
Medline Journal Info:
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Nlm Unique ID: 8804069 Medline TA: Eur J Cardiothorac Surg Country: Germany |
Other Details:
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Languages: eng Pagination: 643-8 Citation Subset: IM |
Affiliation:
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Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA. christian.etz@mountsinai.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Animals Aorta / physiopathology, surgery Aortic Aneurysm / physiopathology, surgery* Arteries / surgery Blood Pressure / physiology Cervical Vertebrae Collateral Circulation / physiology* Disease Models, Animal Evoked Potentials, Motor / physiology Female Intraoperative Period Movement / physiology Necrosis Paraplegia / prevention & control* Perfusion / methods* Postoperative Period Spinal Cord / blood supply*, pathology Swine Thoracic Vertebrae |
| Grant Support | |
ID/Acronym/Agency:
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R01 HL045636-15/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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