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Eur J Cardiothorac Surg 2007;31:643-648. doi:10.1016/j.ejcts.2007.01.023
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented?

^a Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York, USA
^b Department of Neurophysiology, Mount Sinai School of Medicine, New York, New York, USA
^c Department of Pathology, Mount Sinai School of Medicine, New York, New York, USA

Received 10 September 2006; received in revised form 28 December 2006; accepted 5 January 2007.

^_* Corresponding author. Address: Mount Sinai School of Medicine, Department of Cardiothoracic Surgery, One Gustave L. Levy Place, PO-Box: 1028, New York, NY 10029, USA. Tel.: +1 212 659 6800; fax: +1 212 659 6818. (Email: christian.etz{at}mountsinai.org).

Objective: Understanding the ability of the paraspinal anastomotic network to provide adequate spinal cord perfusion pressure (SCPP) critical for both surgical and endovascular repair of thoracoabdominal aortic aneurysms (TAAA). Methods: To monitor pressure in the collateral circulation, a catheter was inserted into the distal end of the divided first lumbar segmental artery (SA) of 10 juvenile Yorkshire pigs (28.9 ± 3.8 kg). SA pairs from T3 through L5 were serially sacrificed at 32 °C; SCPP and function – using motor-evoked potentials (MEPs) – were continuously monitored until 1 h after clamping the last SA. Intermittent aortic and SCPP monitoring was continued for 5 days postoperatively, along with evaluation of motor function. Results: A mean of 14.4 ± 0.7 SAs were sacrificed without loss of MEP. SCPP (mmHg) dropped from 68 ± 7 before SA clamping (77% of aortic pressure) to 22 ± 6 at end clamping, and 21 ± 4 after 1 h, reaching its lowest point – 19 ± 4 – after 5 h. Postoperatively, SCPP recovered to 33 ± 6 at 24 h; 42 ± 10 at 48 h; 56 ± 14 at 72 h; 62 ± 15 at 96 h, returning to baseline (63 ± 20) at 120 h. Despite comparable SCPP patterns, four pigs did not fully regain the ability to stand. Six animals recovered: two could stand and four could walk. Conclusions: Interruption of all SAs at 32 °C in this pig model results in a spectrum of cord injury, with normal function in a majority of pigs postoperatively. The short duration of low SCPP suggests that hemodynamic manipulation lasting only 24–48 h may allow routine complete preservation of normal cord function despite sacrifice of all SAs.

Key Words: Spinal cord perfusion/protection • Paraplegia • Segmental artery sacrifice • Thoracoabdominal aortic aneurysm repair (TAA/A)

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