Document Detail


Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented?
MedLine Citation:
PMID:  17293121     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Christian D Etz; Tobias M Homann; Konstadinos A Plestis; Ning Zhang; Maximilian Luehr; Donald J Weisz; George Kleinman; Randall B Griepp
Publication Detail:
Type:  Journal Article     Date:  2007-02-12
Journal Detail:
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:
Created Date:  2007-03-19     Completed Date:  2007-06-28     Revised Date:  2011-09-22    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  643-8     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA. christian.etz@mountsinai.org
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MeSH Terms
Descriptor/Qualifier:
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:
R01 HL045636-15/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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