Spinal cord injury during selective cerebral perfusion and segmental artery occlusion: an experimental study

• Published in: Interactive cardiovascular and thoracic surgery 2022-01, Vol.34 (1), p.145-152
• Main Authors: Honkanen, Hannu-Pekka, Mustonen, Caius, Tuominen, Hannu, Kiviluoma, Kai, Anttila, Vesa, Juvonen, Tatu
• Format: Article
• Language: English
• Subjects: Animals; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - pathology; Aortic Aneurysm, Thoracic - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - methods; Cerebrovascular Circulation; Extracorporeal Technologies; Humans; Perfusion - adverse effects; Perfusion - methods; Spinal Cord - blood supply; Spinal Cord Injuries - etiology; Spinal Cord Ischemia - etiology; Swine
• ISSN: 1569-9285; 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivab219

Abstract   OBJECTIVES Since selective cerebral perfusion (SCP) has been used in aortic arch surgical procedures, the core temperature during lower body circulatory arrest (LBCA) has been steadily rising. Simultaneously, the use of a frozen elephant trunk (FET) graft has been increasing. The safe period of LBCA in relation to spinal cord ischaemic tolerance in combination with segmental artery occlusion by the FET procedure has not been defined. METHODS Sixteen pigs were assigned to undergo 65 (n = 10) or 90 min (n = 6) of SCP at 28°C with LBCA in combination with occlusion of the 8 uppermost segmental arteries in the thoracic (Th) aorta (15–20 cm FET, Th8-level). The follow-up period consisted of a 6-h intensive period and a 5-day observation period. Near-infrared spectroscopy of the collateral network was used to determine spinal cord oxygenation. The neurological status of the patients was evaluated daily, and the brain and the spinal cord were harvested for a histopathological analysis. RESULTS Five out of 6 pigs after 90 min and 1 out of 10 pigs after 65 min of LBCA died within 48 h of multiorgan failure. Of the survivors in the 65-min group, 6 out of 9 had paraparesis/paraplegia; the remaining 3 reached normal function. The lone survivor after 90 min of LBCA was paraplegic. Nadir near-infrared spectroscopy of the collateral network values at Th8 and Th10 were 34 (±5) and 39 (±4), and they were reached within 35 min of SCP in both groups. CONCLUSIONS An extended FET graft with LBCA and SCP durations >65 min at 28°C results in a poor outcome. Since the widespread use of selective cerebral perfusion (SCP) in aortic arch surgery, acceptable perfusion temperatures have risen steadily.