Prevention of paraplegia in pigs by selective segmental artery perfusion during aortic cross-clamping.
OBJECTIVE
During thoracoabdominal aortic aneurysm repair, a prolonged interruption of the spinal cord blood supply can result in irreversible spinal cord damage. The aim of this study was to investigate whether selective segmental artery perfusion during aortic clamping could prevent paraplegia in pigs.


METHODS
Specially designed segmental artery perfusion catheters, which could be attached to an extracorporeal bypass graft system, were used. In experiment I (n = 10), it was assessed whether selective segmental artery perfusion could reverse electrophysiologic evidence of spinal cord ischemia and maintain transcranial motor evoked potentials (tc-MEPs) during 60 minutes of aortic cross-clamping. The abdominal aorta, containing critical segmental arteries, was bypassed through use of an aortoaortic bypass graft system. After the disappearance of tc-MEPs, an aortotomy was followed by selective segmental artery perfusion. In experiment II (n = 10), the aim was to determine whether selective segmental artery perfusion could prevent paraplegia. In five animals (group A), aortic cross-clamping was followed by selective segmental artery perfusion; five control animals (group B) underwent segmental artery blockade only. Postoperative hind limb function and spinal cord histopathology were evaluated on the third postoperative day.


RESULTS
In experiment I, tc-MEPs disappeared within 3.7 +/- 3.7 minutes after cross-clamping and returned in all animals in 8.5 +/- 5.3 minutes after selective perfusion. During the study period, tc-MEP amplitudes recovered to a median of 49% (range, 28%-113%) of baseline values. Total bypass graft flow was 880 +/- 294 mL/min, of which 184 +/- 54 mL/min was directed to the selective perfusion catheters. The flow in individual catheters was 52 +/- 13 mL/min. In experiment II, all perfused animals demonstrated normal hind limb function, whereas four of five control animals were paraplegic on day 3 (P =.04) In the perfused animals, histopathologic examination showed either no spinal cord damage or eosinophilic neurons only, whereas in paraplegic controls there was infarction in large areas of the cord (P <.0001).


CONCLUSIONS
In pigs, selective segmental artery perfusion can provide sufficient spinal cord blood flow to prevent paraplegia resulting from 60 minutes of aortic clamping, as shown by clinical outcomes and histopathologic examination.
Meylaerts
S A
SA
Departments of Vascular Surgery, Anesthesiology, and Medical Technical Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
De Haan
P
P
Kalkman
C J
CJ
Jaspers
J
J
Vanicky
I
I
Jacobs
M J
MJ
D000818:Animals; D001011:Aorta; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D003250:Constriction; D019054:Evoked Potentials, Motor; D005112:Extracorporeal Circulation; D005260:Female; D007431:Intraoperative Complications / Q000517:prevention & control*; D007511:Ischemia / Q000473:pathology / Q000517:prevention & control*; D010264:Paraplegia / Q000517:prevention & control; D010477:Perfusion / Q000379:methods*; D012039:Regional Blood Flow; D013116:Spinal Cord / Q000098:blood supply* / Q000473:pathology / Q000502:physiology; D013552:Swine