Hannu-Pekka Honkanen1, Caius Mustonen1, Hannu Tuominen2, Kai Kiviluoma1, Vesa Anttila3, Tatu Juvonen1,4. 1. Department of Surgery, Research Unit of Surgery, Anaesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland. 2. Department of Pathology, Oulu University Hospital, Oulu, Finland. 3. Department of Surgery, Heart Center, University of Turku and Turku University Hospital, Turku, Finland. 4. Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
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.
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.
Authors: Christian D Etz; Maximilian Luehr; Fabian A Kari; Hung Mo Lin; George Kleinman; Stefano Zoli; Konstadinos A Plestis; Randall B Griepp Journal: Eur J Cardiothorac Surg Date: 2009-07-28 Impact factor: 4.191
Authors: Malakh Shrestha; Jean Bachet; Joseph Bavaria; Thierry P Carrel; Ruggero De Paulis; Roberto Di Bartolomeo; Christian D Etz; Martin Grabenwöger; Michael Grimm; Axel Haverich; Heinz Jakob; Andreas Martens; Carlos A Mestres; Davide Pacini; Tim Resch; Marc Schepens; Paul P Urbanski; Martin Czerny Journal: Eur J Cardiothorac Surg Date: 2015-03-13 Impact factor: 4.191
Authors: Ruggero De Paulis; Martin Czerny; Luca Weltert; Joseph Bavaria; Michael A Borger; Thierry P Carrel; Christain D Etz; Michael Grimm; Mahmoud Loubani; Davide Pacini; Timothy Resch; Paul P Urbanski; Ernst Weigang Journal: Eur J Cardiothorac Surg Date: 2014-07-17 Impact factor: 4.191
Authors: Paul P Urbanski; Aristidis Lenos; Petros Bougioukakis; Ioannis Neophytou; Michael Zacher; Anno Diegeler Journal: Eur J Cardiothorac Surg Date: 2012-01 Impact factor: 4.191
Authors: Hannu-Pekka Honkanen; Caius Mustonen; Johanna Herajärvi; Hannu Tuominen; Tuomo Starck; Mika Kallio; Kai Kiviluoma; Vesa Anttila; Tatu Juvonen Journal: Semin Thorac Cardiovasc Surg Date: 2020-05-04
Authors: H Jakob; K Tsagakis; D Pacini; R Di Bartolomeo; C Mestres; F Mohr; R Bonser; S Cerny; P Oberwalder; M Grabenwoger Journal: J Cardiovasc Surg (Torino) Date: 2011-10 Impact factor: 1.888
Authors: Justus T Strauch; Alexander Lauten; Ning Zhang; Thorsten Wahlers; Randall B Griepp Journal: Ann Thorac Surg Date: 2007-06 Impact factor: 4.330
Authors: Christian D Etz; Tobias M Homann; Maximilian Luehr; Fabian A Kari; Donald J Weisz; George Kleinman; Konstadinos A Plestis; Randall B Griepp Journal: Eur J Cardiothorac Surg Date: 2008-04-11 Impact factor: 4.191