Spinal cord protection during aortic cross clamping: retrograde venous spinal cord perfusion, distal aortic perfusion, and cerebrospinal fluid drainage.
OBJECTIVE
We investigated retrograde venous spinal cord perfusion (RVP), with the established adjuncts cerebrospinal fluid drainage (CSFD), and distal aortic perfusion (DAP) in the canine model. We then examined the clinical feasibility of RVP, DAP, and CSFD.


METHODS
Canine study: Twenty dogs were randomized to four treatment groups. All animals underwent 60 min of complete aortic cross-clamp. Group 1 was the control and received only aortic cross-clamp; group 2 DAP and CSFD; group 3 DAP, CSFD, and RVP; and group 4 CSFD plus RVP. Human study: Five patients underwent aortic graft replacement of the descending or thoracoabdominal aorta, while receiving CSFD, DAP, and RVP.


RESULTS
Canine study: All animals in groups 1 and 4 awoke paralyzed. One animal each in groups 2 and 3 were paraparetic, with the remaining dogs neurologically intact. Groups 2 and 3 differed from groups 1 and 4 at p < 0.0001. Human study: No mortality or permanent complications were observed in this group.


CONCLUSIONS
While RVP did not reduce neurologic injury, neither did it increase morbidity. In humans the method is technically feasible and free from major problems. Further animal studies and randomized trials are underway at our center.
Winnerkvist
Anders
A
Department of Cardiothoracic and Vascular Surgery, University of Texas Health Sciences Center Medical School, Memorial Hermann Hospital, Houston 77030, USA. hazim.j.safi@uth.tmc.edu
Bartoli
Stefano
S
Iliopoulos
Dimitrios C
DC
Hess
Kenneth R
KR
Miller
Charles C
CC
Safi
Hazim J
HJ
D000368:Aged; D000818:Animals; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D002555:Cerebrospinal Fluid; D003250:Constriction; D004195:Disease Models, Animal; D004285:Dogs; D004322:Drainage / Q000379:methods; D005240:Feasibility Studies; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D007511:Ischemia / Q000517:prevention & control*; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011336:Probability; D011897:Random Allocation; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity; D013116:Spinal Cord / Q000098:blood supply; D013118:Spinal Cord Diseases / Q000517:prevention & control*; D014680:Veins