Distal aortic perfusion during thoracoabdominal aneurysm repair for prevention of paraplegia

Hsu, Charlie; Kwan, Gigi N. C.; Driel, Mieke van; Rophael, John A.

doi:10.1002/14651858.cd008197.pub2

Cited by 10 publications

(6 citation statements)

References 46 publications

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“…Numerous techniques have been used in an attempt to avoid this devastating complication including: temporary shunting, CSF drainage, epidural cooling, systemic cooling, local or systemic pharmacological interventions, spinal cord monitoring, and re-implantation of intercostal arteries. A 2012 Cochrane review stated that observational studies from experienced centres suggest a potential benefit for distal aortic perfusion, however, there are no randomized control trials investigating the use of distal aortic perfusion [17]. For this case femoral arterial pressure was maintained with a target MAP between 70-100 mmHg.…”

Section: Spinal Cord Protectionmentioning

confidence: 99%

Optimizing Outcomes of Open Thoracoabdominal Aortic Aneurysm Repair

2015

JACCOA

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Open thoracoabdominal aortic aneurysm (TAAA) repair is a high-risk surgery associated with significant morbidity and mortality. It can be difficult to accumulate experience managing open TAAA repairs due to the low volume of cases and the increasing popularity of endovascular approaches. It is important to review management strategies for these challenging cases as clinical situations remain for which an open repair is preferred. Recent advances now allow for distal aortic perfusion during an off-pump open thoracoabdominal aortic aneurysm repair. This approach is not without risks and a clear, team based, plan is essential for successful management. Key considerations include managing co-morbidities, spinal cord protection, prevention of ischemia (coronary, cerebral, visceral, and peripheral), renal protection, massive transfusion, rapid hemodynamic changes, acidosis, coagulopathy, one lung ventilation, and postoperative pain control. In this case report, we detail an off-pump perioperative approach involving retrograde aortic perfusion, transesophageal echocardiography, and multiple spinal cord protective strategies which resulted in a favorable patient outcome.

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Section: Spinal Cord Protectionmentioning

confidence: 99%

Optimizing Outcomes of Open Thoracoabdominal Aortic Aneurysm Repair

2015

JACCOA

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“…Such complication is consequence of spinal cord ischaemia, which comes from limited spinal cord blood flow during surgery, for which reports as high as 30% have been described [4] . To protect against such complication, various adjunctive techniques have been developed to maintain appropriate spinal cord circulation and reduce the incidence of spinal cord ischaemia, among such techniques are: cerebrospinal fluid (CSF) drainage to reduce CSF pressure and increase spinal cord perfusion [5] , deep hypothermia which decreases the body’s metabolic activity and oxygen demand [6] , sequential clamping and reattachment of intercostal arteries [7] , and distal aortic perfusion [8] .…”

Section: Introductionmentioning

confidence: 99%

Could Cerebrospinal Fluid Biomarkers Offer Better Predictive Value for Spinal Cord Ischaemia Than Current Neuromonitoring Techniques During Thoracoabdominal Aortic Aneurysm Repair – A Systematic Review

Harky¹,

Fok²,

Fraser³

et al. 2019

Braz J Cardiovasc Surg

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Objective Cerebrospinal fluid (CSF) drainage is a technique that has significantly reduced the incidence of spinal cord ischaemia (SCI). We present results of a systematic review to assess the literature on this topic in relation to thoracoabdominal aortic aneurysm repair (TAAR). Methods Major medical databases were searched to identify papers related to CSF biomarkers measured during TAAAR. Results Fifteen papers reported measurements of CSF biomarkers with 265 patients in total. CSF biomarkers measured included S-100ß, neuron-specific endolase (NSE), lactate, glial fibrillary acidic protein A (GFPa), Tau, heat shock protein 70 and 27 (HSP70, HSP27), and proinflammatory cytokines. Lactate and S-100ß were reported the most, but did not correlate with SCI, which was also the case with NSE and TAU. GFPa showed significant CSF level rises, both intra and postoperative in patients who suffered SCI and warrants further investigation, similar results were seen with HSP70, HSP27 and IL-8. Conclusions Although there is significant interest in this topic, there still remains a significant lack of high-quality studies investigating CSF biomarkers during TAAR to detect SCI. A large and multicentre study is required to identify the significant role of each biomarker.

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“…After years of exploration several therapeutic methods, such as stem cell transplantation 1 and hyperbaric oxygen therapy, 2 have been used to treat patients suffering from SCI. Of all the methods, hypothermia has been used to protect the central nervous system (CNS) after cardiac arrest hypoxic ischemic encephalopathy, 3 aortic aneurysm surgery, [4][5][6] and spinal cord injury, in many experimental and clinical studies. [7][8][9] However, some controversial issues need to be resolved, such as the temperature range, detrimental consequences, the method of introduction, and the duration of hypothermia.…”

Section: Introductionmentioning

confidence: 99%

Beneficial effects of local profound hypothermia and the possible mechanism after experimental spinal cord injury in rats

Zhu

et al. 2015

The Journal of Spinal Cord Medicine

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Objective: The primary focus of this study was to investigate the effects of local profound hypothermia and to explore the possible mechanism in adult rats with spinal cord injury. Study Design and Methods: Spinal cord injury models were established by placing aneurysm clips on T10. An epidural perfusion device was applied to maintain a steady temperature (18°C) for 120 min with gradual rewarming to 37°C Total hypothermic duration lasted up to about 170 min. The expression of axon regeneration inhibitors was tested by Western blot and real-time PCR. Luxol Fast Blue (LFB) stain and Bielschowsky silver stain were used to observe spinal cord morphology. Motor function of the hind limbs (BBB score) was monitored for 21 days. Results: The expressions of RhoA, ROCK-II, NG2, Neurocan, Brevican, and Nogo-A were downregulated by regional hypothermia (RH) after spinal cord injury. Subsequent observation showed that rats that had received RH had an alleviated demyelinating condition and a greater number of nerve fibers. Furthermore, the RH group achieved higher BBB scores than the spinal cord injury (SCI) group. Conclusions: Recovery of hind limb function in rats can be promoted by local profound hypothermia; this may be caused by the suppression of axon regeneration inhibitors.

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Distal aortic perfusion during thoracoabdominal aneurysm repair for prevention of paraplegia

Abstract: Distal aortic perfusion during thoracoabdominal aneurysm repair for prevention of paraplegia.

Cited by 10 publications

References 46 publications

Optimizing Outcomes of Open Thoracoabdominal Aortic Aneurysm Repair

Optimizing Outcomes of Open Thoracoabdominal Aortic Aneurysm Repair

Could Cerebrospinal Fluid Biomarkers Offer Better Predictive Value for Spinal Cord Ischaemia Than Current Neuromonitoring Techniques During Thoracoabdominal Aortic Aneurysm Repair – A Systematic Review

Beneficial effects of local profound hypothermia and the possible mechanism after experimental spinal cord injury in rats

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