ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow References
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
John C. Laschinger
Joseph N. Cunningham, Jr.
Matthew M. Cooper
Frank C. Spencer
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Laschinger, J. C.
Right arrow Articles by Spencer, F. C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Laschinger, J. C.
Right arrow Articles by Spencer, F. C.

Ann Thorac Surg 1983;36:417-426
© 1983 The Society of Thoracic Surgeons

Articles

Experimental and Clinical Assessment of the Adequacy of Partial Bypass in Maintenance of Spinal Cord Blood Flow during Operations on the Thoracic Aorta

John C. Laschinger, M.D., Joseph N. Cunningham, Jr., M.D.*, Ira M. Nathan, Ph.D., Edmond A. Knopp, M.A., Matthew M. Cooper, M.D., Frank C. Spencer, M.D.

Departments of Surgery, Divisions of Cardiovascular Surgery, New York University Medical Center, New York, and Maimonides Medical Center, Brooklyn, NY

* Address reprint requests to Dr. Cunningham, Chief, Division of Cardiovascular and Thoracic Surgery, Maimonides Medical Center, 4802, 10th Ave, Brooklyn, NY 11219

We studied both experimentally and clinically the efficacy of partial bypass techniques in maintaining spinal cord blood flow and physiological function during surgical procedures on the thoracoabdominal aorta. We attempted to define the level of distal aortic pressure required to safely ensure normal neurological function in the absence of critical intercostal occlusion.

Six dogs underwent left thoracotomy with baseline measurements of spinal cord blood flow and spinal cord impulse conduction (somatosensory evoked potentials). Following exclusion of the entire descending thoracic aorta from the left subclavian artery to the T-13 level, partial left atrium-femoral artery bypass was instituted, and baseline levels of proximal and distal aortic pressure were maintained during a 30-minute stabilization period. Mean distal aortic pressure then was progressively altered at 30-minute intervals to 100, 70, and 40 mm Hg. Measurements of spinal cord blood flow and somatosensory evoked potential were repeated at the end of each interval for comparison with baseline.

No significant changes in spinal cord blood flow or somatosensory evoked potential were observed in any animal with a distal aortic pressure greater than or equal to 70 mm Hg. With a pressure of 40 mm Hg, normal flow and somatosensory evoked potentials were maintained in 5 of the 6 dogs. Loss of somatosensory evoked potential, with simultaneous loss of spinal cord blood flow at the T-6 level, occurred in 1 dog. Restoration of distal aortic pressure to 70 mm Hg in all animals resulted in immediate return of somatosensory evoked potential. Loss of somatosensory evoked potential routinely occurred in animals with a distal aortic pressure less than 40 mm Hg.

Clinically, 9 patients have undergone operation for lesions of the thoracoabdominal aorta using shunt or bypass techniques. Normal somatosensory evoked potentials were preserved in 7 patients with maintenance of adequate distal aortic pressure (greater than or equal to 60 mm Hg) without evidence of postoperative neurological deficit. Two patients showed hypotensive somatosensory evoked potential loss (distal aortic pressure less than 40 mm Hg). Prolonged distal hypotension (85 minutes of aortic cross-clamping) in the latter resulted in paraplegia.

We conclude that maintenance of a distal aortic pressure greater than 60 to 70 mm Hg will uniformly preserve spinal cord blood flow in the absence of critical intercostal exclusion. Should distal aortic pressure be inadequate, early reversible changes in the somatosensory evoked potential will alert the surgeon. Failure to institute measures to reverse these changes may result in paraplegia.




This article has been cited by other articles:


Home page
 VascularHome page
L. B. Davidovic, N. Ilic, I. Koncar, M. Dragas, M. Markovic, R. Sindjelic, and N. Savic
Some technical considerations of open thoracoabdominal aortic aneurysm repair in a transition country
Vascular, December 1, 2011; 19(6): 333 - 337.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
N. Ilic, L. B. Davidovic, I. Koncar, M. Dragas, and M. Markovic
Delayed paraplegia in transition countries: Are we missing something?
J. Thorac. Cardiovasc. Surg., September 1, 2010; 140(3): 729 - 730.
[Full Text] [PDF]

Home page
 Card Surg AdultHome page
T. G. Gleason and J. E. Bavaria
Trauma to the Great Vessels
, January 1, 2008; 3(2008): 1333 - 1354.
[Full Text]

Home page
 PERSPECT VASC SURG ENDOVASC THERHome page
T. G. Gleason and L. C. Benjamin
Conventional Open Repair of Descending Thoracic Aortic Aneurysms
Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2007; 19(2): 110 - 121.
[Abstract] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
T. B. Sloan
Electrophysiologic Monitoring during Surgery to Repair the Thoracoabdominal Aorta
Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2004; 8(2): 113 - 125.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
Y. Kuniyoshi, K. Koja, K. Miyagi, M. Shimoji, T. Uezu, K. Arakaki, S. Yamashiro, K. Mabuni, S. Senaha, and Y. Nakasone
Prevention of postoperative paraplegia during thoracoabdominal aortic surgery
Ann. Thorac. Surg., November 1, 2003; 76(5): 1477 - 1484.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
T. G. Gleason and J. E. Bavaria
Trauma to Great Vessels
, January 1, 2003; 2(2003): 1229 - 1250.
[Full Text]

Home page
 Eur J Cardiothorac SurgHome page
T. Mizuno, M. Toyama, N. Tabuchi, H. Wu, and M. Sunamori
Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection
Eur J Cardiothorac Surg, October 1, 2002; 22(4): 504 - 509.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Kazui, C. C. Miller III, and H. J. Safi
Spinal cord protection during descending aortic aneurysm repair
Ann. Thorac. Surg., March 1, 2002; 73(3): 1023 - 1023.
[Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
E. A. Hessel
Bypass Techniques for Descending Thoracic Aortic Surgery
Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2001; 5(4): 293 - 320.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Wada, H. Yao, T. Miyamoto, S. Mukai, and M. Yamamura
Prevention and detection of spinal cord injury during thoracic and thoracoabdominal aortic repairs
Ann. Thorac. Surg., July 1, 2001; 72(1): 80 - 84.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
S. W. Downing, M. G. Cardarelli, J. Sperling, S. Attar, D. C. Wallace, A. Rodriguez, J. Brown, G. J. R. Whitman, and J. S. McLaughlin
Heparinless partial cardiopulmonary bypass for the repair of aortic trauma
J. Thorac. Cardiovasc. Surg., December 1, 2000; 120(6): 1104 - 1111.
[Abstract] [Full Text] [PDF]

Home page
 Asian Cardiovascular and Thoracic AnnalsHome page
A. T. Ulus, U. Tutun, S. Surucu, N. Apaydin, P. Gokce, and S. F. Katircioglu
Functional Outcome in Model of Spinal Cord Ischemia: Use of Enoximone
Asian Cardiovascular and Thoracic Annals, September 1, 2000; 8(3): 216 - 220.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Ueda, H. Shimizu, A. Mori, I. Kashima, K. Moro, and S. Kawada
Selective perfusion of segmental arteries in patients undergoing thoracoabdominal aortic surgery
Ann. Thorac. Surg., July 1, 2000; 70(1): 38 - 43.
[Abstract] [Full Text] [PDF]

Home page
 PerfusionHome page
W. J DeBois, L. N Girardi, S. Lawrence, J. McVey, A. Cahill, B. Elmer, and M. Zanichelli
Perfusion method for thoracoabdominal aneurysm repair using the open distal technique
Perfusion, May 1, 2000; 15(3): 231 - 236.
[Abstract] [PDF]

Home page
 J Child NeurolHome page
C. Limperopoulos, A. Majnemer, B. Rosenblatt, M. Shevell, C. Rohlicek, and C. Tchervenkov
Multixnodality Evoked Potential Findings in Infants With Congenital Heart Defects
J Child Neurol, November 1, 1999; 14(11): 702 - 707.
[Abstract] [PDF]

Home page
 Eur J Cardiothorac SurgHome page
A. Ilhan, U. Koltuksuz, S. Ozen, E. Uz, H. Ciralik, and O. Akyol
The effects of caffeic acid phenethyl ester (CAPE) on spinal cord ischemia/reperfusion injury in rabbits
Eur J Cardiothorac Surg, October 1, 1999; 16(4): 458 - 463.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
U. O. von Oppell
Invited Commentary
Ann. Thorac. Surg., August 1, 1997; 64(2): 388 - 389.
[Full Text]

Home page
 StrokeHome page
G. S. Maharajh, E. A. Pascoe, W. C. Halliday, H. P. Grocott, D. B. Thiessen, L. G. Girling, M. S. Cheang, W. A. C. Mutch, and J. P. Muizelaar
Neurological Outcome in a Porcine Model of Descending Thoracic Aortic Surgery: Left Atrial Femoral Artery Bypass Versus Clamp/Repair
Stroke, November 1, 1996; 27(11): 2095 - 2101.
[Abstract] [Full Text]

Home page
 VASC ENDOVASCULAR SURGHome page
S. F. Katircioglu, P. Gokce, E. Ozgencil, Z. Saritas, E. Sener, B. Yilmazkaya, B. Koc, O. Tasdemir, and K. Bayazit
Prostacyclin Usage for Spinal Cord Protection During Experimental Thoracic Aortic Cross-Clamping
Vascular and Endovascular Surgery, March 1, 1996; 30(2): 97 - 101.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. Kazama, Y. Masaki, S. Maruyama, and A. Ishihara
Effect of altering cerebrospinal fluid pressure on spinal cord blood flow
Ann. Thorac. Surg., July 1, 1994; 58(1): 112 - 115.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Ueno, K. Furukawa, Y. Katayama, H. Suda, and T. Itoh
Spinal cord protection: Development of a paraplegia-preventive solution
Ann. Thorac. Surg., July 1, 1994; 58(1): 116 - 120.
[Abstract] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
Y. Matsui, K. Goh, N. Shiiya, T. Murashita, M. Miyama, J. Ohba, T. Gohda, M. Sakuma, K. Yasuda, and T. Tanabe
Clinical application of evoked spinal cord potentials elicited by direct stimulation of the cord during temporary occlusion of the thoracic aorta
J. Thorac. Cardiovasc. Surg., June 1, 1994; 107(6): 1519 - 1527.
[Abstract] [Full Text]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
A. K. Qayumi, M. T. Janusz, K. Dorovini-Zis, D. M. Lyster, W. R. Eric Jamieson, A. Poostizadeh, E. J. E. Feeley, and M. Nikbakht-Sangari
Additive effect of allopurinol and deferoxamine in the prevention of spinal cord injury caused by aortic crossclamping
J. Thorac. Cardiovasc. Surg., May 1, 1994; 107(5): 1203 - 1209.
[Abstract] [Full Text]

Home page
 Ann. Thorac. Surg.Home page
D. A. Cooley and R. T. Baldwin
Technique of open distal anastomosis for repair of descending thoracic aortic aneurysms
Ann. Thorac. Surg., November 1, 1992; 54(5): 932 - 936.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. M. Agee, T. Flanagan, L. H. Blackbourne, I. L. Kron, and C. G. Tribble
Reducing postischemic paraplegia using conjugated superoxide dismutase
Ann. Thorac. Surg., June 1, 1991; 51(6): 911 - 915.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
F. Wadouh, R. Wadouh, M. Hartmann, and N. Crisp-Lindgren
Prevention of paraplegia during aortic operations
Ann. Thorac. Surg., October 1, 1990; 50(4): 543 - 552.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
C. P. Marini, P. E. Grubbs, B. Toporoff, T. T. Woloszyn, M. S. Coons, A. J. Acinapura, and J. N. Cunningham
Effect of sodium nitroprusside on spinal cord perfusion and paraplegia during aortic cross-clamping
Ann. Thorac. Surg., March 1, 1989; 47(3): 379 - 383.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
G. J. Wilson, I. M. Rebeyka, J. G. Coles, A. J. Desrosiers, H. K. Dasmahapatra, S. Adler, D. A. Feitler, H. Sherret, S. Kielmanowicz, J. Ikonomidis, et al.
Loss of the Somatosensory Evoked Response as an Indicator of Reversible Cerebral Ischemia during Hypothermic, Low-flow Cardiopulmonary Bypass
Ann. Thorac. Surg., February 1, 1988; 45(2): 206 - 209.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. Colon, O. H. Frazier, D. A. Cooley, and H. A. McAllister
Hypothermic Regional Perfusion for Protection of the Spinal Cord During Periods of Ischemia
Ann. Thorac. Surg., June 1, 1987; 43(6): 639 - 643.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
I. M. Rebeyka, J. G. Coles, G. J. Wilson, T. Watanabe, M. J. Taylor, S. F. Adler, D. A. G. Mickle, A. D. Romaschin, H. Ujc, F. A. Burrows, et al.
The Effect of Low-Flow Cardiopulmonary Bypass on Cerebral Function: An Experimental and Clinical Study
Ann. Thorac. Surg., April 1, 1987; 43(4): 391 - 396.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. A. Marvasti, J. A. Meyer, B. E. Ford, and F. B. Parker Jr.
Spinal Cord Ischemia Following Operation for Traumatic Aortic Transection
Ann. Thorac. Surg., October 1, 1986; 42(4): 425 - 428.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
K. H. Lim, M. Connolly, D. Rose, F. Siegman, I. Jacobowitz, A. Acinapura, and J. N. Cunningham Jr.
Prevention of Reperfusion Injury of the Ischemic Spinal Cord: Use of Recombinant Superoxide Dismutase
Ann. Thorac. Surg., September 1, 1986; 42(3): 282 - 286.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. C. Coles, S. N. Ahmed, H. U. Mehta, and J. C. E. Kaufmann
Role of Free Radical Scavenger in Protection of Spinal Cord during Ischemia
Ann. Thorac. Surg., May 1, 1986; 41(5): 551 - 556.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. C. Pollock, M. P. Jamieson, and R. McWilliam
Somatosensory Evoked Potentials in the Detection of Spinal Cord Ischemia in Aortic Coarctation Repair
Ann. Thorac. Surg., March 1, 1986; 41(3): 251 - 254.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
K. L. Mattox, M. Holzman, L. R. Pickard, A. C. Beall Jr., and M. E. DeBakey
Clamp/Repair: A Safe Technique for Treatment of Blunt Injury to the Descending Thoracic Aorta
Ann. Thorac. Surg., November 1, 1985; 40(5): 456 - 463.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. J. Livesay, D. A. Cooley, R. A. Ventemiglia, C. G. Montero, R. K. Warrian, D. M. Brown, and J. M. Duncan
Surgical Experience in Descending Thoracic Aneurysmectomy with and without Adjuncts to Avoid Ischemia
Ann. Thorac. Surg., January 1, 1985; 39(1): 37 - 46.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. C. Laschinger, J. N. Cunningham Jr., M. M. Cooper, K. Krieger, I. M. Nathan, and F. C. Spencer
Prevention of Ischemic Spinal Cord Injury Following Aortic Cross-Clamping: Use of Corticosteroids
Ann. Thorac. Surg., November 1, 1984; 38(5): 500 - 507.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
E. D. Foster
Reoperation for Aortic Coarctation
Ann. Thorac. Surg., July 1, 1984; 38(1): 81 - 89.
[Abstract] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 1983 by The Society of Thoracic Surgeons.