HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): James C. Halstead Christian Etz Randall B. Griepp Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Halstead, J. C. Articles by Griepp, R. B. Search for Related Content PubMed PubMed Citation Articles by Halstead, J. C. Articles by Griepp, R. B. Related Collections Great vessels

Ann Thorac Surg 2007;84:789-794
© 2007 The Society of Thoracic Surgeons

---

Original Articles: Cardiovascular

Preservation of Spinal Cord Function After Extensive Segmental Artery Sacrifice: Regional Variations in Perfusion

^a Department of Cardiothoracic Surgery, Division of Biostatistics, Mount Sinai School of Medicine, New York, New York
^b Department of Neurosurgery, Division of Biostatistics, Mount Sinai School of Medicine, New York, New York
^c Department of Anesthesiology, Division of Biostatistics, Mount Sinai School of Medicine, New York, New York

Accepted for publication April 16, 2007.

^_* Address correspondence to Dr Halstead, Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Pl, New York, NY 10029 (Email: jameschalstead{at}yahoo.co.uk).

Presented at the Basic Science Forum of the Fifty-third Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 8–11, 2006.

Background: Sacrifice of intercostal and lumbar arteries simplifies thoracoabdominal aneurysm surgery and enables endovascular stenting. Little is known about alterations in cord perfusion after extensive segmental artery sacrifice. We explored this question using hypothermia to reduce metabolism.

Methods: Twelve juvenile Yorkshire pigs (mean weight, 22.3 kg) were randomized to segmental artery sacrifice at 32°C or 37°C. Cord integrity was assessed with myogenic-evoked potential (MEP) monitoring. Stepwise craniocaudal sacrifice of segmental arteries was continued until MEP diminution occurred; the last segmental artery was then reopened. Fluorescent microspheres were used to measure spinal cord blood flow (SCBF) at baseline, 5 minutes, 1 hour, and 3 hours after segmental artery sacrifice. Hind limb function was monitored for 5 days.

Results: All animals recovered normal hind limb function. At 32°C, more segmental arteries, 16.5 versus 15 (p = 0.03), could be sacrificed without MEP loss. Baseline SCBF at 32°C was 50% that at 37°C (p = 0.003) and remained fairly stable throughout. At 37°C, SCBF to the craniocaudal extremes of the cord (C1 to T3 and L2 to L6) increased markedly (p = 0.01) at 1 hour and returned toward normal at 3 hours. Concomitantly, SCBF fell in the middle portion of the cord (T9 to T13) at 1 hour before returning to normal at 3 hours.

Conclusions: Almost all segmental arteries can be sacrificed with preservation of spinal cord function. No major change occurs in the central cord in normothermic animals, but there is significant transient hyperemia in segments adjacent to extrasegmental vessels. Hypothermia reduces SCBF and abolishes this possible steal phenomenon. Metabolic and hemodynamic manipulation should enable routine sacrifice of all segmental arteries without spinal cord injury.