Surgery of the Descending Thoracic Aorta: Spinal Cord Protection with the Gott Shunt

Verdant, A; Pagé, A; Cossette, R; Dontigny, L; Pagé, Pierre; Baillot, Richard

doi:10.1016/s0003-4975(10)65887-0

Cited by 73 publications

(10 citation statements)

References 18 publications

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“…16 -20 Verdant et al had particularly good results with the use of a Gott shunt, but their experience was based in surgery for aortic aneurysm. 19 In our hands at least, passive shunts had a mortality rate and neurological deficit incidence similar to patients from the clamp-and-sew group. Molina et al suggested in a interesting animal study that for a shunt to be effective in preventing neurological deficit, it should have a cross-sectional area at least 29% of the descending aorta and should carry 60% of the descending aorta expected blood flow.…”

Section: Evolution Of Surgical Modalitysupporting

confidence: 63%

Management of Traumatic Aortic Rupture: A 30-Year Experience

et al. 2002

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ObjectiveTo present the authors' 30-year experience with traumatic aortic rupture (TAR). Summary Background DataTAR is a highly lethal injury. Most institutions manage a small number of cases, and most surgeons receive only modest exposure during training. MethodsBetween 1971 and 2001, the authors operated on 219 patients with a diagnosis of TAR. Diagnosis of TAR since 1994 has been based exclusively on the use of contrast-enhanced spiral computed tomography, with angiography reserved for equivocal cases (periaortic mediastinal hematoma without aortic wall abnormalities). Patients were divided according to surgical technique. Eighty-two patients (group A) were operated on with a clamp-and-sew technique. Sixty-four patients (group B) underwent surgery with the use of a passive shunt, and 73 patients (group C) were treated using heparin-less partial cardiopulmonary bypass. ResultsMortality was 18 patients for group A (21.9%), 23 patients for group B (35.9%), and 13 patients for group C (17.8%) (P ϭ .03). Paraplegia occurred in 15 of 64 survivors in group A (23.4%), 7 of 41 survivors in group B (17%), and 0 of 60 survivors in group C (P ϭ .0005). Aortic occlusion without lower body perfusion for longer than 30 minutes (P ϭ .004) and surgical technique without lower body bypass support (P ϭ .0005) were associated with paraplegia.

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Section: Evolution Of Surgical Modalitysupporting

confidence: 63%

Management of Traumatic Aortic Rupture: A 30-Year Experience

et al. 2002

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“…11,18,[26][27][28][29][30] Free oxygen radicals can impair the function of the cellular components. 14,15,31 Free oxygen radical-induced damage has been implemented in postischemic cell injury and cell death, while free radical scavengers such as SOD, CAT and GSH-Px are associated with partial amelioration of ischemic injury.…”

Section: Discussionmentioning

confidence: 99%

Protective effect of melatonin on experimental spinal cord ischemia

et al. 2003

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Study design: Experimental animal model to assess ischemic spinal cord injury following occlusion of the thoraco-abdominal aorta. Objectives: To measure whether melatonin administered to rabbits before and after occlusion exerts an effect on the repair of ischemia-reperfusion (IR) injury. Setting: Medical Biology Laboratory, Inonu University, Malatya, Turkey Methods: Rabbits were divided into three IR treatment groups and one sham-operated (ShOp) control group. The three treatment groups had their infrarenal aorta temporarily occluded for 25 min, while the ShOp group had laparotomy without aortic occlusion. Melatonin was administered either 10 min before aortic occlusion or 10 min after the clamp was removed. Physiologic saline was administered to the control animals. After treatment, the animals were euthanized and lumbosacral spinal cord tissue was removed for the determination of relevant enzyme activities. Results: Malondialdehyde levels, indicating the extent of lipid peroxidation, were found to be significantly increased in the nonmelatonin treated (IR) group when compared to the ShOp group. Melatonin, whether given to pre-or post occlusion groups, suppressed malondialdehyde levels below that of the ShOp group. Catalase (CAT) and glutathione peroxidase (GSH-Px) enzyme activities were increased in the IR group compared to the ShOp group. Melatonin given preocclusion resulted in a significant decrease in both CAT and GSH-Px enzyme levels. The superoxide dismutase (SOD) enzyme activity was decreased in the ischemia-reperfusion treatment group. However, the melatonin treatment increased SOD enzyme activity to levels approximating that of the ShOp group. Conclusion: To our knowledge, this is the first study that shows the effects of melatonin administered both pre-and postischemia on induced oxidative damage to injured spinal cords. Our data also expands on reports that melatonin administration may significantly reduce the incidence of spinal cord injury following temporary aortic occlusion.

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“…The key factor in open repairs has been to keep the total aorta cross-clamp time to as short a period as possible, especially less than 45 minutes. 3,359,[361][362][363][364] The latest evolution in managing TRA is the use of endovascular deployed graft covered stents. Although endovascular stent grafting has not been prospectively studied for this clinical scenario, US Food and Drug Administrationapproved devices are being used "off label," with considerable success reported based on retrospective studies.…”

Section: Treatment For the Management Of Traumatic Aortic Rupturementioning

confidence: 99%