Epidural cooling for the prevention of ischemic injury to the spinal cord during aortic occlusion in a rabbit model: Determination of the optimal temperature

Martelli, Eugenio; Cho, Jae-Sung; Mózes, Géza; Gloviczki, Péter

doi:10.1067/mva.2002.121571

Cited by 18 publications

(17 citation statements)

References 40 publications

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“…12 The moderate levels of hypothermia (mean Ϸ26°C) achieved in the at-risk thoracolumbar cord with this method have repeatedly been demonstrated to be protective. 29,34 Similar to the results of others reporting longitudinal experience assessing the impact of adjuncts for cord protection, 8 we could demonstrate that EC had a significant impact on SCI when compared to institutional, historical controls. 35 An identical, statistically significant impact on SCI in patients treated for types I-III TAA was noted in the present study.…”

Section: Discussionsupporting

confidence: 78%

Thoracoabdominal Aneurysm Repair: Results With 337 Operations Performed Over a 15-Year Interval

Cambria¹,

Clouse²,

Davison³

et al. 2002

Annals of Surgery

334

221

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ObjectiveTo review perioperative results and late survival after thoracoabdominal aneurysm repair (TAA), in particular to assess the impact over time of epidural cooling (EC) on spinal cord ischemic complications (SCI). Summary Background DataA variety of operative approaches and protective adjuncts have been used in TAA to minimize the major complications of perioperative death and SCI. There is no consensus with respect to the optimal approach. MethodsFrom January 1987 to November 2001, 337 consecutive TAA repairs were performed by a single surgeon. Clinical features included prior aortic grafts in 97 (28.8%) and emergent operation in 82 (24.6%), including rupture in 46 (13.6%) and dissection in 63 (19%). Operative management consisted of a clamp/sew technique with adjuncts in 93%. EC (since July 1993) to prevent SCI was used in 194 (57.6%) repairs. Variables associated with the end points of operative mortality and postoperative SCI were assessed with the Fisher exact test and logistic regression; late survival was estimated with the Kaplan-Meier method. ResultsOperative mortality was 8.3% and was associated with nonelective operation, intraoperative hypotension, total transfusion requirement, and the postoperative complications of paraplegia, renal failure, and pulmonary insufficiency. Postoperative renal failure and transfusion requirement were independent correlates of mortality. SCI of any severity occurred in 38 of 334 (11.4%) operative survivors, with 22/38 (6.6% of cohort) sustaining total paraplegia. EC reduced the risk of SCI in patients with types I-III TAA (10.6% vs. 19.8%, P ϭ .04). Independent correlates of SCI over the entire study interval included types I/II TAA, rupture, cross-clamp duration, sacrifice of T9 -L1 intercostal vessels, and intraoperative hypotension. Late survival rates at 2 and 5 years were 81.2 Ϯ 3% and 67.2 Ϯ 5%. ConclusionsEC has decreased the risk of SCI after TAA repair. Decreasing the substantial proportion (nearly 25%) of patients requiring nonelective operation will improve results. Late survival is equal to that after routine AAA repair, indicating that the considerable resource expenditure required for TAA repair is worthwhile.Despite advances in endoluminal grafting for isolated thoracic and infrarenal aortic aneurysm, open operation remains the only feasible treatment option for thoracoabdominal aneurysm (TAA). Since TAA extent is relatively uncommon in the spectrum of degenerative aneurysm disease, experience and clinical reports have been largely concentrated in a modest number of centers. Even in such environments, operative mortality is generally in the 10%

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Section: Discussionsupporting

confidence: 78%

Thoracoabdominal Aneurysm Repair: Results With 337 Operations Performed Over a 15-Year Interval

Cambria¹,

Clouse²,

Davison³

et al. 2002

Annals of Surgery

334

221

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“…The examination included a count of the viable neurons per section in the ventral gray matter and a graded histological damage scoring (Table I). 13 Slides were examined by a pathologist blinded to the experimental protocol. Readings from 3 sections were taken and values were averaged at 24, 72, and 120 hours after reperfusion.…”

Section: Methodsmentioning

confidence: 99%

Interleukin-1 receptor antagonist attenuates the severity of spinal cord ischemic injury in rabbits

Akuzawa

Kazui

Shi

et al. 2008

Journal of Vascular Surgery

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“…Several experiments have demonstrated that regional cooling by infusing cold saline into the intrathecal or epidural space protects against ischemic spinal cord insult. [43][44][45] Cambria et al 46 and Tabayashi et al 47 described favorable clinical results of this procedure. However, it might cause a detrimental increase in CSF pressure.…”

Section: Mild Hypothermiamentioning

confidence: 88%

Current strategies for spinal cord protection during thoracic and thoracoabdominal aortic aneurysm repair

Shimizu

Yozu

2011

Gen Thorac Cardiovasc Surg

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Surgery for thoracoabdominal aortic aneurysms remains challenging, with high mortality and morbidity rates despite overall improvements in the outcome of aortic surgery. Paraplegia and paraparesis remain devastating complications that severely restrict the chance of survival as well as the postoperative quality of life. Preventive measures vary considerably because the causes of spinal cord insufficiency are multifactorial. Here, we review measures to prevent paraplegia/paraparesis arising after surgery for thoracic and thoracoabdominal aortic aneurysms.

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Epidural cooling for the prevention of ischemic injury to the spinal cord during aortic occlusion in a rabbit model: Determination of the optimal temperature

Cited by 18 publications

References 40 publications

Thoracoabdominal Aneurysm Repair: Results With 337 Operations Performed Over a 15-Year Interval

Thoracoabdominal Aneurysm Repair: Results With 337 Operations Performed Over a 15-Year Interval

Interleukin-1 receptor antagonist attenuates the severity of spinal cord ischemic injury in rabbits

Current strategies for spinal cord protection during thoracic and thoracoabdominal aortic aneurysm repair

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