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Ann Thorac Surg 2005;80:1833-1834
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

Invited commentary

Jan D. Galla, MD, PhD

111 Myrtle St, Haworth, NJ07641

(Email: jdgalla@optonline.net).

The first 20% of the full text of this article appears below.

The most dreaded complication associated with thoracic aortic surgery remains paraplegia caused by spinal cord ischemia. The existence of this problem has been known since the early days of aortic surgery and much research, both clinical and experimental, has been devoted to the understanding and prevention of spinal cord injury. Intraoperative and perioperative adjuncts have included both pharmacological and surgical approaches. Varying degrees of success have been reported for each new approach, with some remedies coming and going in and out of fashion as continued research either supports or refutes their effectiveness. Rather than finding any one therapy that completely removes the threat of perioperative spinal cord injury, incremental improvements in surgical and anesthetic regimens have greatly reduced the incidence of this complication to an acceptable level.

Among the earliest adjuncts used in the battle against paraplegia was hypothermia. In studies dating back 50 years, Pontius and colleagues demonstrated that systemic hypothermia successfully allowed prolongation of the spinal cord ischemic interval in laboratory dogs [1]. For many years, the combination of . . . [Full Text of this Article]






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