Abstract

 

OBJECTIVES

Since selective cerebral perfusion (SCP) has been used in aortic arch surgical procedures, the core temperature during lower body circulatory arrest (LBCA) has been steadily rising. Simultaneously, the use of a frozen elephant trunk (FET) graft has been increasing. The safe period of LBCA in relation to spinal cord ischaemic tolerance in combination with segmental artery occlusion by the FET procedure has not been defined.

METHODS

Sixteen pigs were assigned to undergo 65 (n = 10) or 90 min (n = 6) of SCP at 28°C with LBCA in combination with occlusion of the 8 uppermost segmental arteries in the thoracic (Th) aorta (15–20 cm FET, Th8-level). The follow-up period consisted of a 6-h intensive period and a 5-day observation period. Near-infrared spectroscopy of the collateral network was used to determine spinal cord oxygenation. The neurological status of the patients was evaluated daily, and the brain and the spinal cord were harvested for a histopathological analysis.

RESULTS

Five out of 6 pigs after 90 min and 1 out of 10 pigs after 65 min of LBCA died within 48 h of multiorgan failure. Of the survivors in the 65-min group, 6 out of 9 had paraparesis/paraplegia; the remaining 3 reached normal function. The lone survivor after 90 min of LBCA was paraplegic. Nadir near-infrared spectroscopy of the collateral network values at Th8 and Th10 were 34 (±5) and 39 (±4), and they were reached within 35 min of SCP in both groups.

CONCLUSIONS

An extended FET graft with LBCA and SCP durations >65 min at 28°C results in a poor outcome.

中文翻译：

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选择性脑灌注和节段性动脉闭塞期间的脊髓损伤：一项实验研究

摘要

 

目标

由于选择性脑灌注 (SCP) 已用于主动脉弓外科手术，下半身停循环 (LBCA) 期间的核心温度一直在稳步上升。同时，冷冻象鼻（FET）移植物的使用也在增加。尚未确定 LBCA 与 FET 手术联合节段性动脉闭塞的脊髓缺血耐受相关的安全期。

方法

16 头猪被分配在 28°C 下接受 65 ( n  = 10) 或 90 分钟 ( n  = 6) 的 SCP，同时使用 LBCA 并阻塞胸主动脉 (Th) 中最上部的 8 节动脉 (15–20 cm) FET，Th8 级）。随访期包括 6 小时的强化期和 5 天的观察期。侧支网络的近红外光谱用于确定脊髓氧合。每天评估患者的神经状态，并采集大脑和脊髓进行组织病理学分析。

结果

LBCA 90 分钟后 6 头猪中有 5 头和 LBCA 65 分钟后 10 头猪中有 1 头在多器官衰竭的 48 小时内死亡。在 65 分钟组的幸存者中，9 人中有 6 人患有轻瘫/截瘫；其余3个达到正常功能。LBCA 90 分钟后唯一的幸存者截瘫。Th8 和 Th10 侧支网络的最低​​近红外光谱值分别为 34 (±5) 和 39 (±4)，两组均在 SCP 后 35 分钟内达到。

结论

LBCA 和 SCP 持续时间在 28°C 下 > 65 分钟的扩展 FET 移植物会导致不良结果。