Cooling catheter for spinal cord preservation in thoracic aortic surgery.
OBJECTIVE
Despite advances in spinal cord protection, paraplegia continues to be a serious complication of descending and thoracoabdominal aortic operations. We devised and tested a novel, self-contained catheter designed to cool the spinal cord topically after being threaded into the spinal column.


METHODS
A cooling catheter for this purpose was specifically designed and produced. The catheter has two lumina, one for ingress and one for egress of fluid. The system is self-contained, so that the fluid does not communicate in any way with the spinal fluid. A console device circulates cold fluid through the catheter. The catheter was tested in 5 adult sheep, with direct monitoring of core body temperature and spinal cord temperature in both active cooling and passive re-warming cycles.


RESULTS
In testing in 4 sheep (five attempted implants, with one failure), the catheter worked without problem, producing effective cooling of the spinal cord, from a mean temperature of 36.8 degrees C (core temperature) to 30.5 degrees C (spinal temperature) (P<0.0001). In no case did post-mortem examination or histology reveal any evidence of damage to the spinal cord from hypothermia. Temperature rose toward body temperature after cessation of active cooling.


CONCLUSIONS
Effective topical cooling of the spinal cord can be achieved via a specially designed, self-contained cooling catheter placed into the intra-thecal space. This catheter holds promise for spinal cord protection in aortic surgery. Also, this catheter may be useful as well in mitigating injury to the spinal cord in cases of traumatic spinal column injury.
Moomiaie
R M A
RM
Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT 06510, USA.
Ransden
J
J
Stein
J
J
Strugar
J
J
Zhu
Q B
QB
Kim
J H
JH
Elefteriades
J A
JA
D000818:Animals; D001013:Aorta, Thoracic / Q000601:surgery*; D002404:Catheterization / Q000295:instrumentation*; D004867:Equipment Design; D007036:Hypothermia, Induced / Q000295:instrumentation*; D007431:Intraoperative Complications / Q000517:prevention & control; D007511:Ischemia / Q000150:complications / Q000517:prevention & control*; D010264:Paraplegia / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D012756:Sheep; D013116:Spinal Cord / Q000098:blood supply*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*