Konstantin von Aspern1, Josephina Haunschild2, Martin Ziemann3, Martin Misfeld4, Friedrich W Mohr4, Michael A Borger4, Christian D Etz2. 1. University Department for Cardiac Surgery, Leipzig Heart Center, Saxony, Germany; University of Leipzig, Saxonian Incubator for Clinical Translation, Saxony, Germany. Electronic address: Konstantin_vonAspern@Uni-Leipzig.de. 2. University Department for Cardiac Surgery, Leipzig Heart Center, Saxony, Germany; University of Leipzig, Saxonian Incubator for Clinical Translation, Saxony, Germany. 3. University of Leipzig, Saxonian Incubator for Clinical Translation, Saxony, Germany. 4. University Department for Cardiac Surgery, Leipzig Heart Center, Saxony, Germany.
Abstract
OBJECTIVE: Ischemic spinal cord injury remains the most devastating complication after open and endovascular aortic repair. Collateral network near-infrared spectroscopy has been introduced to noninvasively monitor real-time spinal cord oxygenation. In view of recent advancements in endovascular treatment and minimally invasive staged preconditioning before aortic repair, this study sought to evaluate collateral network near-infrared spectroscopy during and after segmental artery occlusion in a chronic porcine model. METHODS: Surgery for segmental artery occlusion was performed in 12 juvenile pigs, and bilateral lumbar collateral network near-infrared spectroscopy was recorded. Two intervention groups were designed: Group 1 received subtotal segmental artery occlusion (mimicking reimplantation of crucial segmental arteries with patent T12/T13, N = 5), and group 2 received total occlusion (T4-L5, N = 7). Pigs were monitored over 3 days. RESULTS: All animals were paraplegic during the first 24 hours. The subtotal occlusion group completely recovered, whereas 57% of the total occlusion group remained paraplegic (N = 4/7). After segmental artery occlusion, collateral network near-infrared spectroscopy decreased from 92.3% ± 8% of baseline to 69.3% ± 18% after 10 minutes in the subtotal group (P = .003-.017) and from 90.1% ± 4% to 58.2% ± 9% in the total group (P < .001-.008). Throughout the postoperative period, collateral network near-infrared spectroscopy in the total occlusion group remained lower compared with the subtotal group (<30% baseline threshold, P < .05). Lumbar collateral network near-infrared spectroscopy and neurologic outcome were significantly correlated (R = 0.7, P < .001). CONCLUSIONS: Lumbar collateral network near-infrared spectroscopy reacts to occlusion of segmental arteries and correlates with neurologic outcome. The preliminary data suggest that collateral network near-infrared spectroscopy may be a valuable noninvasive tool for detecting imminent spinal cord ischemia during and after aortic procedures involving segmental artery occlusion.
OBJECTIVE: Ischemic spinal cord injury remains the most devastating complication after open and endovascular aortic repair. Collateral network near-infrared spectroscopy has been introduced to noninvasively monitor real-time spinal cord oxygenation. In view of recent advancements in endovascular treatment and minimally invasive staged preconditioning before aortic repair, this study sought to evaluate collateral network near-infrared spectroscopy during and after segmental artery occlusion in a chronic porcine model. METHODS: Surgery for segmental artery occlusion was performed in 12 juvenile pigs, and bilateral lumbar collateral network near-infrared spectroscopy was recorded. Two intervention groups were designed: Group 1 received subtotal segmental artery occlusion (mimicking reimplantation of crucial segmental arteries with patent T12/T13, N = 5), and group 2 received total occlusion (T4-L5, N = 7). Pigs were monitored over 3 days. RESULTS: All animals were paraplegic during the first 24 hours. The subtotal occlusion group completely recovered, whereas 57% of the total occlusion group remained paraplegic (N = 4/7). After segmental artery occlusion, collateral network near-infrared spectroscopy decreased from 92.3% ± 8% of baseline to 69.3% ± 18% after 10 minutes in the subtotal group (P = .003-.017) and from 90.1% ± 4% to 58.2% ± 9% in the total group (P < .001-.008). Throughout the postoperative period, collateral network near-infrared spectroscopy in the total occlusion group remained lower compared with the subtotal group (<30% baseline threshold, P < .05). Lumbar collateral network near-infrared spectroscopy and neurologic outcome were significantly correlated (R = 0.7, P < .001). CONCLUSIONS: Lumbar collateral network near-infrared spectroscopy reacts to occlusion of segmental arteries and correlates with neurologic outcome. The preliminary data suggest that collateral network near-infrared spectroscopy may be a valuable noninvasive tool for detecting imminent spinal cord ischemia during and after aortic procedures involving segmental artery occlusion.