Improvement in thoracic aortic pressure after proximal aortic cross-clamping by balloon occlusion of the distal aorta.
Spinal cord hypoperfusion injury is a devastating complication of cross-clamping the proximal thoracic aorta. The collateral circulation around the cross-clamp is generally poorly developed, and the run-off is immense, resulting in extremely low thoracic aortic and spinal cord perfusion pressures. The authors postulated that balloon occlusion of the abdominal aorta might confine this reduced collateral flow around the cross-clamp to the thoracic aorta. In 8 of 16 dogs subjected to aortic cross-clamping of the aorta just beyond the arch vessels, the abdominal aorta was also occluded by a balloon. Thoracic aortic pressure and spinal cord perfusion pressure were significantly higher in the animals with aortic balloon occlusion than in those without balloon occlusion (77 +/- 8 mm Hg versus 26 +/- 1 mm Hg, p less than 0.01, and 67 +/- 8 mm Hg versus 18 +/- 2 mm Hg, p less than 0.01, at 10 minutes after cross-clamping). Abdominal aortic balloon occlusion increases thoracic aortic pressure after the aorta is cross-clamped proximally. Further studies are necessary in primates to assess the effect of this procedure in spinal cord perfusion and the rate of paraplegia.
Spence
P A
PA
Division of Cardiac Surgery, East Carolina University, School of Medicine, Greenville, NC 27858-4354.
Lust
R M
RM
Sun
Y S
YS
Iida
H
H
Pollock
S B
SB
Williams
J M
JM
Austin
E H
EH
D000818:Animals; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002555:Cerebrospinal Fluid / Q000737:chemistry; D015170:Cerebrospinal Fluid Pressure; D003097:Collateral Circulation; D004195:Disease Models, Animal; D004285:Dogs; D011651:Pulmonary Artery; D013119:Spinal Cord Injuries / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control