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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024; 118:5-115. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
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2
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Soliman MA, Ramadan A, Shah AS, Corr SJ, Abdelazeem B, Rahimi M. Postoperative Spinal Cord Ischemia Monitoring: A Review of Techniques Available after Endovascular Aortic Repair. Ann Vasc Surg 2024; 106:438-466. [PMID: 38815914 DOI: 10.1016/j.avsg.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Spinal cord ischemia is one of the complications that can occur after open and endovascular thoracoabdominal aortic repair. This occurs despite various perioperative approaches, including distal aortic perfusion, hybrid procedures with extra anatomical bypasses, motor-evoked potential, and cerebrospinal fluid drainage. The inability to recognize spinal ischemia in a timely manner remains a devastating complication after thoracoabdominal aortic repair.This review aims to look at novel technologies that are designed for continuous monitoring to detect early changes that signal the development of spinal cord ischemia and to discuss their benefits and limitations. METHODS We conducted a systematic review of the technologies available for continuous monitoring in the intensive care unit for early detection of spinal cord ischemia. Studies were eligible for inclusion if they used different technologies for monitoring spinal ischemia during the postoperative period. All articles that were not available in English were excluded. To ensure that all relevant articles were included, no other significant restrictions were imposed. RESULTS We identified 59 studies from the outset to December 2022 to be included in our study. New techniques have been studied as potentially useful monitoring tools that could provide simple and effective monitoring of the spinal cord. These include near-infrared spectroscopy, contrast-enhanced ultrasound, magnetic resonance imaging, fiber optic monitoring of the spinal cord, and cerebrospinal fluid biomarkers. CONCLUSIONS Despite the development of new techniques to monitor for postoperative spinal cord ischemia, their use remains limited. We recommend more future research to ensure rapid intervention for our patients.
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Affiliation(s)
| | - Alaa Ramadan
- Faculty of Medicine, South Valley University, Qena, Egypt
| | - Anuj S Shah
- Cardiovascular Surgery Department, Houston Methodist Hospital, TX
| | - Stuart J Corr
- Cardiovascular Surgery Department, Houston Methodist Hospital, TX
| | - Basel Abdelazeem
- Cardiology Department, West Virginia University, Morgantown, West Virginia
| | - Maham Rahimi
- Cardiovascular Surgery Department, Houston Methodist Hospital, TX
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3
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Caulier-Cisterna R, Appelgren-Gonzáles JP, Oyarzún JE, Valenzuela F, Sitaram R, Eblen-Zajjur A, Uribe S. Comparison of LED- and LASER-based fNIRS technologies to record the human peri‑spinal cord neurovascular response. Med Eng Phys 2024; 127:104170. [PMID: 38692767 DOI: 10.1016/j.medengphy.2024.104170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 03/13/2024] [Accepted: 04/11/2024] [Indexed: 05/03/2024]
Abstract
Recently, functional Near-Infrared Spectroscopy (fNIRS) was applied to obtain, non-invasively, the human peri‑spinal Neuro-Vascular Response (NVR) under a non-noxious electrical stimulation of a peripheral nerve. This method allowed the measurements of changes in the concentration of oxyhemoglobin (O2Hb) and deoxyhemoglobin (HHb) from the peri‑spinal vascular network. However, there is a lack of clarity about the potential differences in perispinal NVR recorded by the different fNIRS technologies currently available. In this work, the two main noninvasive fNIRS technologies were compared, i.e., LED and LASER-based. The recording of the human peri‑spinal NVR induced by non-noxious electrical stimulation of a peripheral nerve was recorded simultaneously at C7 and T10 vertebral levels. The amplitude, rise time, and full width at half maximum duration of the perispinal NVRs were characterized in healthy volunteers and compared between both systems. The main difference was that the LED-based system shows about one order of magnitude higher values of amplitude than the LASER-based system. No statistical differences were found for rise time and for duration parameters (at thoracic level). The comparison of point-to-point wave patterns did not show significant differences between both systems. In conclusion, the peri‑spinal NRV response obtained by different fNIRS technologies was reproducible, and only the amplitude showed differences, probably due to the power of the system which should be considered when assessing the human peri‑spinal vascular network.
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Affiliation(s)
- Raúl Caulier-Cisterna
- Department of Informatics and Computing, Faculty of Engineering, Universidad Tecnológica Metropolitana, Santiago, Chile.
| | - Juan-Pablo Appelgren-Gonzáles
- Center for Biomedical Imaging, the Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan-Esteban Oyarzún
- Center for Biomedical Imaging, the Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
| | - Felipe Valenzuela
- Center for Biomedical Imaging, the Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ranganatha Sitaram
- Diagnostic Imaging Department, Multimodal Functional Brain Imaging and Neurorehabilitation Hub, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Antonio Eblen-Zajjur
- Translational Neuroscience Laboratory, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Sergio Uribe
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
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4
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
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5
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Vanpeteghem CM, De Hert SG, Moerman AT. Blood pressure control with phenylephrine or dobutamine: a randomized controlled trial comparing effects on cerebral and paravertebral tissue oxygen saturation measured with near-infrared spectroscopy. J Clin Monit Comput 2023; 37:1161-1169. [PMID: 37195621 DOI: 10.1007/s10877-023-01023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/19/2023] [Indexed: 05/18/2023]
Abstract
Preserving haemodynamics is expected to positively affect tissue oxygen saturation. We hypothesized that maintaining mean arterial blood pressure (MAP) (using phenylephrine (PE) or dobutamine (Dobu)) would equally affect regional cerebral and paravertebral tissue saturation (rScO2 and rSpvO2, respectively). Thirty-four patients were randomly assigned to receive either PE or Dobu, in order to keep MAP within 20% of the preoperative value. Their effect on haemodynamics, rScO2 and rSpvO2 at thoracic level T3-T4, T9-T10 and lumbar level L1-L2 was calculated at different doses. Drug-induced haemodynamic effects differed between groups (∆MAP: -2%±21 and - 19%±17, ∆CI: -14.6%±14.6 and 24.1%±49.9, ∆HR: -21%±21 and 0%±16 for PE and Dobu, respectively). Both groups exhibited a significant decrease in rScO2, with a more pronounced decline in the PE group (-14.1%±16.1) compared to the Dobu group (-5.9%±10.6). There were no significant changes at the paravertebral level in either group, but a slight but statistically significant difference was detected between the two groups at T3-T4 and L1-L2. Current guidelines advocate maintaining adequate systemic blood pressures to prevent spinal cord ischaemia in specific procedures. However, it is still unknown which circulatory supportive drug is more beneficial for maintaining spinal cord perfusion. Our data indicates that, when used for maintenance of blood pressure within a 20% range of preoperative values, neither phenylephrine nor dobutamine affect paravertebral tissue saturation.
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Affiliation(s)
- Caroline M Vanpeteghem
- Department of Anesthesiology and Perioperative Medicine, University Hospital Ghent, Corneel Heymanslaan 10, Ghent, 9000, Belgium.
| | - Stefan G De Hert
- Department of Anesthesiology and Perioperative Medicine, University Hospital Ghent, Corneel Heymanslaan 10, Ghent, 9000, Belgium
| | - Anneliese T Moerman
- Department of Anesthesiology and Perioperative Medicine, University Hospital Ghent, Corneel Heymanslaan 10, Ghent, 9000, Belgium
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6
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von Aspern K, Haunschild J, Garbade J, Etz CD. Near-Infrared Spectroscopy for Spinal Cord Monitoring-A Roadmap to Translational Research in Aortic Medicine. AORTA (STAMFORD, CONN.) 2023; 11:145-151. [PMID: 37949108 PMCID: PMC11038735 DOI: 10.1055/s-0043-1772774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 07/19/2023] [Indexed: 11/12/2023]
Abstract
Extensive aortic aneurysms represent a unique challenge necessitating interdisciplinary efforts for safe and effective treatment. Despite various adjunctive neuroprotective strategies, ischemic spinal cord injury remains a devastating complication. This article describes the implementation of collateral network near-infrared spectroscopy as the first noninvasive spinal cord monitoring modality in the setting of extensive open and endovascular aortic repair, from early conceptualization to clinical utilization. Potential capabilities and remaining uncertainties based on current evidence are outlined and discussed.
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Affiliation(s)
| | - Josephina Haunschild
- Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Saxony, Germany
| | - Jens Garbade
- Department for Cardiothoracic Surgery, Klinikum Links der Weser, Bremen, Germany
| | - Christian D. Etz
- Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Saxony, Germany
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7
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Schachner T, Gottardi R, Schmidli J, Wyss TR, Van Den Berg JC, Tsilimparis N, Bavaria J, Bertoglio L, Martens A, Czerny M. Practice of neuromonitoring in open and endovascular thoracoabdominal aortic repair-an international expert-based modified Delphi consensus study. Eur J Cardiothorac Surg 2023; 63:ezad198. [PMID: 37252816 DOI: 10.1093/ejcts/ezad198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/21/2023] [Accepted: 05/12/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES Spinal cord injury is detrimental for patients undergoing open or endovascular thoracoabdominal aortic aneurysm (TAAA) repair. The aim of this survey and of the modified Delphi consensus was to gather information on current practices and standards in neuroprotection in patients undergoing open and endovascular TAAA. METHODS The Aortic Association conducted an international online survey on neuromonitoring in open and endovascular TAAA repair. In a first round an expert panel put together a survey on different aspects of neuromonitoring. Based on the answers from the first round of the survey, 18 Delphi consensus questions were formulated. RESULTS A total of 56 physicians completed the survey. Of these, 45 perform open and endovascular TAAA repair, 3 do open TAAA repair and 8 do endovascular TAAA repair. At least 1 neuromonitoring or protection modality is utilized during open TAAA surgery. Cerebrospinal fluid (CSF) drainage was used in 97.9%, near infrared spectroscopy in 70.8% and motor evoked potentials or somatosensory evoked potentials in 60.4%. Three of 53 centres do not utilize any form of neuromonitoring or protection during endovascular TAAA repair: 92.5% use CSF drainage; 35.8%, cerebral or paravertebral near infrared spectroscopy; and 24.5% motor evoked potentials or somatosensory evoked potentials. The utilization of CSF drainage and neuromonitoring varies depending on the extent of the TAAA repair. CONCLUSIONS The results of this survey and of the Delphi consensus show that there is broad consensus on the importance of protecting the spinal cord to avoid spinal cord injury in patients undergoing open TAAA repair. Those measures are less frequently utilized in patients undergoing endovascular TAAA repair but should be considered, especially in patients who require extensive coverage of the thoracoabdominal aorta.
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Affiliation(s)
- Thomas Schachner
- University Clinic of Cardiac Surgery and University Clinic of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Roman Gottardi
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Friberg, Germany
| | - Jürg Schmidli
- Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R Wyss
- Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Kantonsspital Winterthur, Department of Interventional Radiology and Vascular Surgery, Winterthur, Switzerland
| | - Jos C Van Den Berg
- Centro Vascolare Ticino, Ospedale Regionale di Lugano, sede Civico Inselspital, Universitätsspital Bern Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie, Switzerland
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, Germany
| | - Joseph Bavaria
- Department of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Luca Bertoglio
- Division of Vascular Surgery, Vita Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Milano, Italy
| | - Andreas Martens
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Friberg, Germany
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8
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Taher F, Hofmann A, Assadian A. Precision Medicine in Vascular and Endovascular Surgery. J Clin Med 2023; 12:jcm12031031. [PMID: 36769679 PMCID: PMC9917631 DOI: 10.3390/jcm12031031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Personalized medicine and precision medicine are terms often used to refer to treatment strategies tailored specifically to individual characteristics of patients, as opposed to a one-size fits all approach [...].
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Affiliation(s)
- Fadi Taher
- Correspondence: ; Tel.: +43-(14)-91504107
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Oberhuber A, Raddatz A, Betge S, Ploenes C, Ito W, Janosi RA, Ott C, Langheim E, Czerny M, Puls R, Maßmann A, Zeyer K, Schelzig H. Interdisciplinary German clinical practice guidelines on the management of type B aortic dissection. GEFASSCHIRURGIE 2023; 28:1-28. [PMCID: PMC10123596 DOI: 10.1007/s00772-023-00995-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 08/13/2023]
Affiliation(s)
- A. Oberhuber
- German Society of Vascular Surgery and Vascular Medicine (DGG); Department of Vascular and Endovascular Surgery, University Hospital of Münster, Münster, Germany
| | - A. Raddatz
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI); Department of Anaesthesiology, Critical Care and Pain Medicine, Saarland University Hospital, Homburg, Germany
| | - S. Betge
- German Society of Angiology and Vascular Medicine (DGG); Department of Internal Medicine and Angiology, Helios Hospital Salzgitter, Salzgitter, Germany
| | - C. Ploenes
- German Society of Geriatrics (DGG); Department of Angiology, Schön Klinik Düsseldorf, Düsseldorf, Germany
| | - W. Ito
- German Society of Internal Medicine (GSIM) (DGIM); cardiovascular center Oberallgäu Kempten, Hospital Kempten, Kempten, Germany
| | - R. A. Janosi
- German Cardiac Society (DGK); Department of Cardiology and Angiology, University Hospital Essen, Essen, Germany
| | - C. Ott
- German Society of Nephrology (DGfN); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Hypertension, Paracelsus Medical University, Nürnberg, Germany
| | - E. Langheim
- German Society of prevention and rehabilitation of cardiovascular diseaese (DGPR), Reha Center Seehof, Teltow, Germany
| | - M. Czerny
- German Society of Thoracic and Cardiovascular Surgery (DGTHG), Department University Heart Center Freiburg – Bad Krozingen, Freiburg, Germany
- Albert Ludwigs University Freiburg, Freiburg, Germany
| | - R. Puls
- German Radiologic Society (DRG); Institute of Diagnostic an Interventional Radiology and Neuroradiology, Helios Klinikum Erfurt, Erfurt, Germany
| | - A. Maßmann
- German Society of Interventional Radiology (DeGIR); Department of Diagnostic an Interventional Radiology, Saarland University Hospital, Homburg, Germany
| | - K. Zeyer
- Marfanhilfe e. V., Weiden, Germany
| | - H. Schelzig
- German Society of Surgery (DGCH); Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
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10
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Rinaldi E, Loschi D, Favia N, Santoro A, Chiesa R, Melissano G. Spinal Cord Ischemia in Open and Endovascular Aortic Repair. AORTA (STAMFORD, CONN.) 2022; 10:194-200. [PMID: 36521813 PMCID: PMC9754877 DOI: 10.1055/s-0042-1756669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Despite the improvements, spinal cord ischemia is still one of the major and most dramatic potential complications after thoracic and thoracoabdominal aortic treatments, for both open and endovascular procedures. A multimodal approach, which includes several intraoperative and postoperative maneuvers, may contribute to optimizing the spinal cord tolerance to ischemia. The aim of this article is to report the different techniques employed to improve spinal cord perfusion, directly and indirectly through collateral circulation.
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Affiliation(s)
- Enrico Rinaldi
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy,Address for correspondence Enrico Rinaldi, MD Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele UniversityVia Olgettina, 60, 20132 MilanItaly
| | - Diletta Loschi
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Favia
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Annarita Santoro
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Chiesa
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Germano Melissano
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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11
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Giustiniano E, Nisi F, Palma S, Pisciotta W, Ruggieri N, Barbieri F, Civilini E, Maurizio C. Near-infrared spectroscopy to monitor spinal cord oxygenation in οpen thoraco-abdominal aortic surgery. A case series. HELLENIC JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022:111-119. [DOI: 10.59037/hjves.v4i4.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Objectives. We adopted the near-infrared spectroscopy (NIRS) technology to monitor the spinal oxygen supply through the paraspinous muscles oxygenation in agreement with the concept of “collateral network” circulation. We retrospectively investigated our database of subjects who underwent thoraco-abdominal aorta open repair assessing for the reliability of this monitoring to predict spinal cord injury.
Methods. Consecutive patients who underwent elective thoraco-abdominal aorta open repair between March 2019
and September 2021. In addition to standard monitoring, patients received the monitoring of the paraspinous muscles
oxygenation by NIRS.
Results. In one patient a significant drop of the mean arterial pressure (49 mmHg) and the spinal-cord perfusion pressure
(31 mmHg) occurred after the aortic clamping, with a contemporary lowering of the left-side oxygenation of paraspinous muscles (<40%). Both the blood pressure and the spinal cord perfusion pressure were restored within 10 minutes, but the oxygenation remained at an unsafe level (<55%) until the end of the surgery. This same patient experienced a lower-limb paralysis post-operatively. It did not happen in the other 11 cases of the sample.
Conclusions. The main finding of our retrospective analysis indicates reliability of this technology to monitor the spinal
cord oxygenation during open thoraco-abdominal aortic surgery and possibly predict spinal cord injury. Still, several
questions need to be addressed about the suitability of this technology to the anatomic and pathophysiology of the
spinal cord circulation
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Affiliation(s)
- Enrico Giustiniano
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Fulvio Nisi
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Sergio Palma
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Walter Pisciotta
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Nadia Ruggieri
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Francesca Barbieri
- Vascular Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Efrem Civilini
- Vascular Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Cecconi Maurizio
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
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12
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Graber M, Nägele F, Röhrs BT, Hirsch J, Pölzl L, Moriggl B, Mayr A, Troger F, Kirchmair E, Wagner JF, Nowosielski M, Mayer L, Voelkl J, Tancevski I, Meyer D, Grimm M, Knoflach M, Holfeld J, Gollmann-Tepeköylü C. Prevention of Oxidative Damage in Spinal Cord Ischemia Upon Aortic Surgery: First-In-Human Results of Shock Wave Therapy Prove Safety and Feasibility. J Am Heart Assoc 2022; 11:e026076. [PMID: 36216458 DOI: 10.1161/jaha.122.026076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Spinal cord ischemia (SCI) remains a devastating complication after aortic dissection or repair. A primary hypoxic damage is followed by a secondary damage resulting in further cellular loss via apoptosis. Affected patients have a poor prognosis and limited therapeutic options. Shock wave therapy (SWT) improves functional outcome, neuronal degeneration and survival in murine spinal cord injury. In this first-in-human study we treated 5 patients with spinal cord ischemia with SWT aiming to prove safety and feasibility. Methods and Results Human neurons were subjected to ischemic injury with subsequent SWT. Reactive oxygen species and cellular apoptosis were quantified using flow cytometry. Signaling of the antioxidative transcription factor NRF2 (nuclear factor erythroid 2-related factor 2) and immune receptor Toll-like receptor 3 (TLR3) were analyzed. To assess whether SWT act via a conserved mechanism, transgenic tlr3-/- zebrafish created via CRISPR/Cas9 were subjected to spinal cord injury. To translate our findings into a clinical setting, 5 patients with SCI underwent SWT. Baseline analysis and follow-up (6 months) included assessment of American Spinal Cord Injury Association (ASIA) impairment scale, evaluation of Spinal Cord Independence Measure score and World Health Organization Quality of Life questionnaire. SWT reduced the number of reactive oxygen species positive cells and apoptosis upon ischemia via induction of the antioxidative factor nuclear factor erythroid 2-related factor 2. Inhibition or deletion of tlr3 impaired axonal growth after spinal cord lesion in zebrafish, whereas tlr3 stimulation enhanced spinal regeneration. In a first-in-human study, we treated 5 patients with SCI using SWT (mean age, 65.3 years). Four patients presented with acute aortic dissection (80%), 2 of them exhibited preoperative neurological symptoms (40%). Impairment was ASIA A in 1 patient (20%), ASIA B in 3 patients (60%), and ASIA D in 1 patient (20%) at baseline. At follow-up, 2 patients were graded as ASIA A (40%) and 3 patients as ASIA B (60%). Spinal cord independence measure score showed significant improvement. Examination of World Health Organization Quality of Life questionnaires revealed increased scores at follow-up. Conclusions SWT reduces oxidative damage upon SCI via immune receptor TLR3. The first-in-human application proved safety and feasibility in patients with SCI. SWT could therefore become a powerful regenerative treatment option for this devastating injury.
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Affiliation(s)
- Michael Graber
- Department of Cardiac Surgery Medical University of Innsbruck Austria
| | - Felix Nägele
- Department of Cardiac Surgery Medical University of Innsbruck Austria
| | | | - Jakob Hirsch
- Department of Cardiac Surgery Medical University of Innsbruck Austria
| | - Leo Pölzl
- Department of Cardiac Surgery Medical University of Innsbruck Austria
| | - Bernhard Moriggl
- Division of Clinical and Functional Anatomy Medical University of Innsbruck Austria
| | - Agnes Mayr
- Department of Radiology Medical University of Innsbruck Austria
| | - Felix Troger
- Department of Radiology Medical University of Innsbruck Austria
| | - Elke Kirchmair
- Department of Cardiac Surgery Medical University of Innsbruck Austria
| | | | | | - Lukas Mayer
- Department of Neurology Medical University of Innsbruck Austria
| | - Jakob Voelkl
- Institute for Physiology and Pathophysiology Johannes Kepler University Linz Linz Austria.,Department of Nephrology and Medical Intensive Care Charité-Universitätsmedizin Berlin Berlin Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin Berlin Germany
| | - Ivan Tancevski
- Department of Internal Medicine II Medical University of Innsbruck Austria
| | - Dirk Meyer
- Institute of Molecular Biology/CMBI University of Innsbruck Austria
| | - Michael Grimm
- Department of Cardiac Surgery Medical University of Innsbruck Austria
| | | | - Johannes Holfeld
- Department of Cardiac Surgery Medical University of Innsbruck Austria
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13
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Motyl CM, Beck AW. Strategies for prevention and treatment of spinal cord ischemia during F/BEVAR. Semin Vasc Surg 2022; 35:297-305. [DOI: 10.1053/j.semvascsurg.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022]
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14
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Mainard N, Tsiakaka O, Li S, Denoulet J, Messaoudene K, Vialle R, Feruglio S. Intraoperative Optical Monitoring of Spinal Cord Hemodynamics Using Multiwavelength Imaging System. SENSORS (BASEL, SWITZERLAND) 2022; 22:3840. [PMID: 35632249 PMCID: PMC9146887 DOI: 10.3390/s22103840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 12/10/2022]
Abstract
The spinal cord is a major structure of the central nervous system allowing, among other things, the transmission of afferent sensory and efferent motor information. During spinal surgery, such as scoliosis correction, this structure can be damaged, resulting in major neurological damage to the patient. To date, there is no direct way to monitor the oxygenation of the spinal cord intraoperatively to reflect its vitality. This is essential information that would allow surgeons to adapt their procedure in case of ischemic suffering of the spinal cord. We report the development of a specific device to monitor the functional status of biological tissues with high resolution. The device, operating with multiple wavelengths, uses Near-InfraRed Spectroscopy (NIRS) in combination with other additional sensors, including ElectroNeuroGraphy (ENG). In this paper, we focused primarily on aspects of the PhotoPlethysmoGram (PPG), emanating from four different light sources to show in real time and record biological signals from the spinal cord in transmission and reflection modes. This multispectral system was successfully tested in in vivo experiments on the spinal cord of a pig for specific medical applications.
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Affiliation(s)
- Nicolas Mainard
- Department of Pediatric Surgery, Jeanne-de-Flandre Hospital, CHU Lille, Avenue Eugène-Avinée, 59000 Lille, France
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
| | - Olivier Tsiakaka
- CERVO, Biomedical Microsystems Laboratory, Université Laval, Quebec, QC G1V 0A6, Canada;
| | - Songlin Li
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
| | - Julien Denoulet
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
| | - Karim Messaoudene
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
| | - Raphael Vialle
- Clinical Research Group “RIC” Robotics and Surgical Innovations, GRC-33 Sorbonne University, 26 Avenue du Dr. Arnold Netter, 75012 Paris, France;
| | - Sylvain Feruglio
- Laboratoire D’Informatique de Paris 6 (LIP6), CNRS UMR7606, Sorbonne Université, 4 Place Jussieu, CEDEX 05, 75252 Paris, France; (S.L.); (J.D.); (K.M.); (S.F.)
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15
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Valenzuela F, Rana M, Sitaram R, Uribe S, Eblen-Zajjur A. Non-Invasive Functional Evaluation of the Human Spinal Cord by Assessing the Peri-Spinal Neurovascular Network With Near Infrared Spectroscopy. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2312-2321. [PMID: 34705650 DOI: 10.1109/tnsre.2021.3123587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Current medical care lacks an effective functional evaluation for the spinal cord. Magnetic resonance imaging and computed tomography mainly provide structural information of the spinal cord, while spinal somatosensory evoked potentials are limited by a low signal to noise ratio. We developed a non-invasive approach based on near-infrared spectroscopy in dual-wavelength (760 and 850 nm for deoxy- or oxyhemoglobin respectively) to record the neurovascular response (NVR) of the peri-spinal vascular network at the 7th cervical and 10th thoracic vertebral levels of the spinal cord, triggered by unilateral median nerve electrical stimulation (square pulse, 5-10 mA, 5 ms, 1 pulse every 4 minutes) at the wrist. Amplitude, rise-time, and duration of NVR were characterized in 20 healthy participants. A single, painless stimulus was able to elicit a high signal-to-noise ratio and multi-segmental NVR (mainly from Oxyhemoglobin) with a fast rise time of 6.18 [4.4-10.4] seconds (median [Percentile 25-75]) followed by a slow decay phase for about 30 seconds toward the baseline. Cervical NVR was earlier and larger than thoracic and no left/right asymmetry was detected. Stimulus intensity/NVR amplitude fitted to a 2nd order function. The characterization and feasibility of the peri-spinal NVR strongly support the potential clinical applications for a functional assessment of spinal cord lesions.
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16
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von Aspern K, Haunschild J, Heier M, Ossmann S, Mohr FW, Borger MA, Etz CD. Experimental near-infrared spectroscopy-guided minimally invasive segmental artery occlusion. Eur J Cardiothorac Surg 2021; 60:48-55. [PMID: 33538301 DOI: 10.1093/ejcts/ezab005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/28/2020] [Accepted: 12/11/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Minimally invasive staged segmental artery (SA) coil- and plug embolization is a new method for paraplegia prevention associated with extensive aortic procedures. Near-infrared spectroscopy of the paraspinal collateral network (cnNIRS) has emerged as a non-invasive method for spinal cord monitoring. The aim of this study was to evaluate cnNIRS to guide minimally invasive SA occlusion. METHODS In a chronic large animal experiment, 18 juvenile pigs underwent two-stage minimally invasive staged SA coil- and plug embolization for complete SA occlusion. Coil-embolization was performed either by SA main stem occlusion (characteristic of pig anatomy) or separately for the left- and right SA. Lumbar cnNIRS was recorded during and after the procedure. Neurological status was assessed up to 3 days after complete SA occlusion. RESULTS Mean time from SA coil embolization to minimum cnNIRS values was 11 ± 5 min with an average decrease from 101 ± 2% to 78 ± 8% of baseline (difference: -23 ± 9, P < 0.001). Lumbar cnNIRS demonstrated significant differences between left and right when SAs were occluded separately in all cases (-7 ± 4%, 1 min after first SA occlusion; P = 0.001). Permanent paraplegia occurred in 2 (11%) and any kind of neurological deficit-temporary or permanent-in 7 animals (39%). Association between lumbar cnNIRS and neurological outcome after minimally invasive staged SA coil- and plug embolization suggests positive correlation (R = 0.5, P = 0.052). CONCLUSIONS Lumbar cnNIRS independently reacts to unilateral SA occlusion. cnNIRS-guided SA occlusion is feasible and may become a useful adjunct facilitating adequate and complete vessel occlusion.
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Affiliation(s)
- Konstantin von Aspern
- University Department for Cardiac Surgery, Leipzig Heart Center, Saxony, Germany.,University of Leipzig, Saxonian Incubator for Clinical Translation (SIKT), Saxony, Germany
| | - Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, Saxony, Germany.,University of Leipzig, Saxonian Incubator for Clinical Translation (SIKT), Saxony, Germany
| | - Marcus Heier
- University of Leipzig, Medical Faculty, Leipzig, Germany
| | - Susann Ossmann
- University Department for Cardiac Surgery, Leipzig Heart Center, Saxony, Germany
| | - Friedrich W Mohr
- University Department for Cardiac Surgery, Leipzig Heart Center, Saxony, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Saxony, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Saxony, Germany.,University of Leipzig, Saxonian Incubator for Clinical Translation (SIKT), Saxony, Germany
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17
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Ali J, Cody J, Maldonado Y, Ramakrishna H. Near-Infrared Spectroscopy (NIRS) for Cerebral and Tissue Oximetry: Analysis of Evolving Applications. J Cardiothorac Vasc Anesth 2021; 36:2758-2766. [PMID: 34362641 DOI: 10.1053/j.jvca.2021.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/11/2022]
Abstract
THE USE OF NEAR-INFRARED SPECTROSCOPY (NIRS) has increased significantly worldwide in the past decade. This technology, first described more than 40 years ago, is based on the fact that near-infrared light is able to penetrate biologic tissue and can obtain real-time, noninvasive information on tissue oxygenation and metabolism. In the clinical setting, NIRS has been able to provide clinicians potentially valuable information in patients with impaired microcirculations (systemic and cerebral). Near-infrared spectroscopy has progressed beyond assessment of brain oxygenation to monitor local tissue and muscle oxygenation and perfusion. This review analyzes the published data and provides the clinician a comprehensive account of the perioperative utility of NIRS in cardiac, vascular and thoracic surgery, as well as its increasing role in tissue/muscle oxygenation monitoring.
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Affiliation(s)
- Jafer Ali
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Joseph Cody
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, The Ohio State Wexner Medical Center, Columbus, OH
| | - Yasdet Maldonado
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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18
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von Aspern K, Sgouropoulou S, Davierwala P, Borger MA, Etz CD. Spinal cord monitoring using collateral network near-infrared spectroscopy during extended aortic arch surgery with a frozen elephant trunk. J Surg Case Rep 2021; 2021:rjab174. [PMID: 33981408 PMCID: PMC8104940 DOI: 10.1093/jscr/rjab174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
The true incidence of spinal cord injury associated with modern hybrid extended arch/descending aortic procedures utilizing a frozen elephant trunk (fET) remains unclear, and it is estimated with ~5-8%. Prolonged distal arrest without sufficient hypothermic protection as well as extended coverage of segmental arteries have been suggested to cause this complication, previously uncommon in open arch surgery. Recently, extensive clinical and experimental research led to the implementation of a new method of collateral network near-infrared spectroscopy (cnNIRS) to non-invasively monitor spinal cord oxygenation in the setting of extensive thoracoabdominal aortic repair. To date, limited experience with this method during arch procedures exists. Based on recent experiments regarding the optimal cnNIRS optode placement, we used this method for the first time during an fET procedure to document mid-thoracic paraspinous oxygenation levels.
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Affiliation(s)
| | - Sophia Sgouropoulou
- Department of Anaesthesiology and Intensive Care Medicine, Leipzig Heart Center, Leipzig, Germany
| | - Piroze Davierwala
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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19
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Kish B, Herr S, Yang HCS, Sun S, Shi R, Tong Y. Whole body measurements using near-infrared spectroscopy in a rat spinal cord contusion injury model. J Spinal Cord Med 2021; 46:508-520. [PMID: 33890843 PMCID: PMC10116927 DOI: 10.1080/10790268.2021.1911504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Spinal cord injuries cause great damage to the central nervous system as well as the peripheral vasculature. While treatments for spinal cord injury typically focus on the spine itself, improvements in the function of the peripheral vasculature after spinal cord injury have shown to improve overall neurological recovery. OBJECTIVE This study focused on the use of near-infrared spectroscopy (NIRS) as a mode to monitor cerebral and peripheral vascular condition non-invasively during the recovery process. DESIGN Animal research study. METHODS Rats underwent spinal contusion or sham injury and relative concentrations of de-/oxyhemoglobin (Δ[HbO]/Δ[Hb]) over time were measured over the cerebral, spinal, and pedal regions via NIRS. Correlational relationships across the body were determined. Rats received 1 NIRS measurement before injury and 3 after injury: 4, 7, and 14 days post. RESULTS Correlational relationships between signals across the body, between animals with and without spinal cord injury, indicate that NIRS was able to detect patterns of vascular change in the spine and the periphery occurring secondary to spinal cord injury and evolving during subsequent recovery. Additionally, NIRS determined an overall correlational decrease within the central nervous system, between spinal and cerebral measurements. CONCLUSION NIRS was able to closely reflect physiologic changes in the rat during recovery, demonstrating a promising method to monitor whole body hemodynamics after spinal cord injury.
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Affiliation(s)
- Brianna Kish
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Seth Herr
- Center for Paralysis Research and Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Ho-Ching Shawn Yang
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Siyuan Sun
- Center for Paralysis Research and Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Riyi Shi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA.,Center for Paralysis Research and Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Yunjie Tong
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
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20
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Fujioka S, Kitamura T, Mishima T, Nakajima R, Tamura Y, Horikoshi R, Araki H, Yakuwa K, Tomoyasu T, Okamura T, Miyamoto T, Torii S, Miyaji K. Gluteal Blood Flow Monitoring in Endovascular Aneurysm Repair With Internal Iliac Artery Embolization. Circ J 2021; 85:345-350. [PMID: 33597321 DOI: 10.1253/circj.cj-20-1002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND When an internal iliac artery (IIA) has to be embolized during endovascular aneurysm repair (EVAR), buttock claudication sometimes poses problems. However, there is no established method to evaluate intraoperative blood flow to the gluteal muscles.Methods and Results:Gluteal regional oxygen saturation (rSO2) was monitored using near-infrared spectroscopy (NIRS) during surgery, and changes in rSO2were compared with treatment results. Twenty-seven patients who underwent EVAR and IIA embolization at our institution between April 2019 and May 2020 were included in this study. The association between intraoperative changes in rSO2and postoperative incidence of buttock claudication was analyzed. Furthermore, the presence or absence of communication between the superior and inferior gluteal arteries and the intraoperative changes in rSO2were compared to ascertain whether rSO2reflects blood flow change. Postoperative buttock claudication occurred in 4 of 19 patients (21%) with unilateral occlusion of IIA and in 4 of 8 patients (50%) with bilateral occlusion of IIAs. rSO2was found to decrease significantly further in patients with buttock claudication than in patients without buttock claudication (-15±12% vs. -4±16%, P<0.05). In addition, rSO2was predominantly lower in patients without the communication between the superior and inferior gluteal arteries than in those with the communication. CONCLUSIONS Gluteal rSO2is useful as an indicator of intraoperative gluteal blood flow.
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Affiliation(s)
- Shunichiro Fujioka
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Toshiaki Mishima
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Riko Nakajima
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Yoshimi Tamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Rihito Horikoshi
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Haruna Araki
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Kazuki Yakuwa
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Takahiro Tomoyasu
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Toru Okamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Takashi Miyamoto
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Shinzo Torii
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
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21
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Haunschild J, VON Aspern K, Misfeld M, Davierwala P, Borger MA, Etz CD. Spinal cord protection in thoracoabdominal aortic aneurysm surgery: a multimodal approach. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:316-325. [PMID: 33496426 DOI: 10.23736/s0021-9509.21.11783-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Spinal cord injury (SCI) is one major complication of open and endovascular thoracic and thoracoabdominal aortic aneurysm repair. Despite numerous neuroprotective adjuncts, the incidence of SCI remains high. This review article discusses established and novel adjuncts for spinal cord protection, including priming and preconditioning of the paraspinal collateral network, intraoperative systemic hypothermia, distal aortic perfusion, motor- and somatosensory evoked potentials and noninvasive cnNIRS monitoring as well as peri- and postoperative drainage of cerebrospinal fluid. Regardless of the positive influence of many of these strategies on neurologic outcome, to date no strategy assures definitive preservation of spinal cord integrity during and after aortic aneurysm repair.
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Affiliation(s)
| | | | - Martin Misfeld
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, Australia.,Institute of Academic Surgery, RPAH, Sydney, Australia.,The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia
| | - Piroze Davierwala
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Christian D Etz
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany -
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[Near-infrared spectroscopy : Technique, development, current use and perspectives]. Anaesthesist 2020; 70:190-203. [PMID: 32930804 DOI: 10.1007/s00101-020-00837-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Near-infrared spectroscopy (NIRS) has been available in research and clinical practice for more than four decades. Recently, there have been numerous publications and substantial developments in the field. This article describes the clinical application of NIRS in relation to current guidelines, with a focus on pediatric and cardiac anesthesia. It discusses technical and physiological principles, pitfalls in clinical use and presents (patho)physiological influencing factors and derived variables, such as fractional oxygen extraction (FOE) and the cerebral oxygen index (COx). Recommendations for the interpretation of NIRS values in connection with influencing factors, such as oxygen transport capacity, gas exchange and circulation as well as an algorithm for cardiac anesthesia are presented. Limitations of the method and the lack of comparability of values from different devices as well as generally accepted standard values are explained. Technical differences and advantages compared to pulse oxymetry and transcranial Doppler sonography are illuminated. Finally, the prognostic significance and requirements for future clinical studies are discussed.
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Commentary: Going transesophageal will make your monitoring simpler! JTCVS Tech 2020; 4:36-37. [PMID: 34317959 PMCID: PMC8306879 DOI: 10.1016/j.xjtc.2020.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 11/21/2022] Open
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Simoniuk UD, Haunschild J, von Aspern K, Boschmann M, Klug L, Khachatryan Z, Bianchi E, Ossmann S, Oo AY, Borger MA, Etz CD. Near real-time bedside detection of spinal cord ischaemia during aortic repair by microdialysis of the cerebrospinal fluid. Eur J Cardiothorac Surg 2020; 58:629-637. [PMID: 32359065 DOI: 10.1093/ejcts/ezaa124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/11/2020] [Accepted: 02/04/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Spinal cord ischaemia (SCI) remains the most devastating complication after thoraco-abdominal aortic aneurysm (TAAA) repair. Its early detection is crucial if therapeutic interventions are to be successful. Cerebrospinal fluid (CSF) is readily available and accessible to microdialysis (MD) capable of detecting metabolites involved in SCI [i.e. lactate, pyruvate, the lactate/pyruvate ratio (LPR), glucose and glycerol] in real time. Our aim was to evaluate the feasibility of CSF MD for the real-time detection of SCI metabolites. METHODS In a combined experimental and translational approach, CSF MD was evaluated (i) in an established experimental large animal model of SCI with 2 arms: (a) after aortic cross-clamping (AXC, N = 4), simulating open TAAA repair and (b) after total segmental artery sacrifice (Th4-L5, N = 8) simulating thoracic endovascular aortic repair. The CSF was analysed utilizing MD every 15 min. Additionally, CSF was collected hourly from 6 patients undergoing open TAAA repair in a high-volume aortic reference centre and analysed using CSF MD. RESULTS In the experimental AXC group, CSF lactate increased 3-fold after 10 min and 10-fold after 60 min of SCI. Analogously, the LPR increased 5-fold by the end of the main AXC period. Average glucose levels demonstrated a 1.5-fold increase at the end of the first (preconditioning) AXC period (0.60±0.14 vs 0.97±0.32 mmol/l); however, they decreased below (to 1/3 of) baseline levels (0.60±0.14 vs 0.19±0.13 mmol/l) by the end of the experiment (after simulated distal arrest). In the experimental segmental artery sacrifice group, lactate levels doubled and the LPR increased 3.3-fold within 30 min and continued to increase steadily almost 5-fold 180 min after total segmental artery sacrifice (P < 0.05). In patients undergoing TAAA repair, lactate similarly increased 5-fold during ischaemia, reaching a maximum at 6 h postoperatively. In 2 patients with intraoperative SCI, indicated by a decrease in the motor evoked potential of >50%, the LPR increased by 200%. CONCLUSIONS CSF is widely available during and after TAAA repair, and CSF MD is feasible for detection of early anaerobic metabolites of SCI. CSF MD is a promising new tool combining bedside availability and real-time capacity to potentially enable rapid detection of imminent SCI, thereby maximizing chances to prevent permanent paraplegia in patients with TAAA.
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Affiliation(s)
- Urszula D Simoniuk
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany.,Saxon Incubator for Clinical Translation (SIKT), University Leipzig, Leipzig, Germany.,Department of Cardiothoracic Surgery, Barts Heart Centre, London, UK
| | - Josephina Haunschild
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany.,Saxon Incubator for Clinical Translation (SIKT), University Leipzig, Leipzig, Germany
| | - Konstantin von Aspern
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany.,Saxon Incubator for Clinical Translation (SIKT), University Leipzig, Leipzig, Germany
| | - Michael Boschmann
- Experimental & Clinical Research Center, a joint co-operation between Charité Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Lars Klug
- Experimental & Clinical Research Center, a joint co-operation between Charité Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Zara Khachatryan
- Saxon Incubator for Clinical Translation (SIKT), University Leipzig, Leipzig, Germany
| | - Edoardo Bianchi
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Susann Ossmann
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Aung Y Oo
- Department of Cardiothoracic Surgery, Barts Heart Centre, London, UK
| | - Michael A Borger
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Christian D Etz
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany.,Saxon Incubator for Clinical Translation (SIKT), University Leipzig, Leipzig, Germany
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von Aspern K, Haunschild J, Khachatryan Z, Simoniuk U, Ossmann S, Borger MA, Etz CD. Mapping the collateral network: Optimal near-infrared spectroscopy optode placement. J Thorac Cardiovasc Surg 2020; 164:e3-e15. [DOI: 10.1016/j.jtcvs.2020.07.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/10/2020] [Accepted: 07/22/2020] [Indexed: 11/17/2022]
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26
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Honkanen HP, Mustonen C, Herajärvi J, Tuominen H, Starck T, Kallio M, Kiviluoma K, Anttila V, Juvonen T. Remote Ischemic Preconditioning in Spinal Cord Protection: A Surviving Porcine Study. Semin Thorac Cardiovasc Surg 2020; 32:788-796. [PMID: 32380237 DOI: 10.1053/j.semtcvs.2020.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 11/11/2022]
Abstract
Surgical repair of thoracic aorta can compromise blood flow of the spinal cord. To mitigate spinal cord ischemia (SCI) additional protection methods are needed. In experimental studies remote ischemic preconditioning (RIPC) has proven to be an effective method of protecting organs from ischemia. The aim of the study was to assess efficacy of RIPC in spinal cord protection in a chronic porcine model. Sixteen piglets were assigned into the RIPC group (8) and the control group (8). RIPC was performed using blood pressure cuff in a 5-minute ischemia followed by a 5-minute reperfusion repeating cycles 4 times. The left subclavian artery and all segmental arteries above diaphragm were ligated at 5-minute intervals to accomplish SCI. The follow-up comprised a 4-hour intensive monitoring and a 7-day recovery phase. Blood samples were obtained, motor-evoked potentials and near-infrared spectroscopy (NIRS) of longitudinal back muscles were measured. Paraplegia was assessed every day postoperatively. Histopathological analysis of the spinal cord was performed after 7 days. NIRS values 4 hours after SCI were higher in the RIPC group, 45.5 (44.5-47.0), than in the control group, 41.5 (40.5-44.0) (P = 0.042). Nadir value of NIRS was 43.4 (39.3-46.0) in the RIPC group and 38.9 (38.-40.0) in the control group (P = 0.014). On the first postoperative day the RIPC group reached modified Tarlov score of 3 (2-3) vs 2 (1-2) in the control group (P = 0.024). RIPC hastens the recovery from SCI during the first postoperative day.
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Affiliation(s)
- Hannu-Pekka Honkanen
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland.
| | - Caius Mustonen
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland
| | - Johanna Herajärvi
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland
| | - Hannu Tuominen
- Department of Pathology, Oulu University Hospital, Oulu, Finland
| | - Tuomo Starck
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Department of Neurophysiology, Oulu University Hospital, Oulu, Finland
| | - Mika Kallio
- Department of Neurophysiology, Oulu University Hospital, Oulu, Finland
| | - Kai Kiviluoma
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland
| | - Vesa Anttila
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Tatu Juvonen
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland; Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
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Tanaka A, Charlton-Ouw KM. Open thoracoabdominal aortic aneurysm repair in the endovascular era. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.23736/s1824-4777.19.01428-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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28
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Kurita T, Kawashima S, Morita K, Nakajima Y. Spinal cord autoregulation using near-infrared spectroscopy under normal, hypovolemic, and post-fluid resuscitation conditions in a swine model: a comparison with cerebral autoregulation. J Intensive Care 2020; 8:27. [PMID: 32318269 PMCID: PMC7158138 DOI: 10.1186/s40560-020-00443-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/31/2020] [Indexed: 11/17/2022] Open
Abstract
Background Few studies have investigated spinal cord autoregulation using near-infrared spectroscopy (NIRS). Here, we assessed spinal cord autoregulation under normal, hypovolemic, and post-fluid resuscitation conditions compared with cerebral autoregulation. Methods Ten pigs (36.1 ± 1.1 kg) were anesthetized with 2.5% isoflurane, before phenylephrine administration at 0.5, 1, 2, and 5 μg kg−1 min−1 in a stepwise fashion at 10-min intervals (baseline), followed by similar administration of sodium nitroprusside (SNP). Hypovolemia was induced by a 600-ml bleed (25% estimated total blood volume). Only phenylephrine was readministered (same protocol). Hypovolemia was reversed by infusing 600 ml hydroxyethyl starch, before readministering phenylephrine and SNP. The relationships between mean arterial pressure (MAP) and cerebral, thoracic, and lumbar spinal cord tissue oxygenation indices (TOIs) were evaluated. Results Thoracic and lumbar spinal cord TOIs were approximately 15% and 10% lower, respectively, than the cerebral TOI at similar MAPs. The average relationship between MAP and each TOI showed an autoregulatory pattern, but negative correlations were observed in the cerebral TOI during phenylephrine infusion. A 600-ml bleed lowered each relationship < 5% and subsequent fluid resuscitation did not change the relationship. Individual oxygenation responses to blood pressure indicated that the spinal cord is more pressure-passive than the cerebrum. Paradoxical responses (an inverse relationship of tissue oxygenation to MAP) were observed particularly in cerebrum during phenylephrine infusion and were rare in the spinal cord. Conclusions Spinal cord autoregulation is less robust than cerebral autoregulation and more pressure-dependent. Similar to cerebral oxygenation, spinal cord oxygenation is volume-tolerant but is more sensitive to hypotension.
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Affiliation(s)
- Tadayoshi Kurita
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192 Japan
| | - Shingo Kawashima
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192 Japan
| | - Koji Morita
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192 Japan
| | - Yoshiki Nakajima
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192 Japan
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Vanpeteghem CM, Bruneel BY, Lecoutere IM, De Hert SG, Moerman AT. Ephedrine and phenylephrine induce opposite changes in cerebral and paraspinal tissue oxygen saturation, measured with near-infrared spectroscopy: a randomized controlled trial. J Clin Monit Comput 2020; 34:253-259. [PMID: 31165350 DOI: 10.1007/s10877-019-00328-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/28/2019] [Indexed: 11/24/2022]
Abstract
While the effects of phenylephrine (PE) and ephedrine (E) on cerebral oxygen saturation (rScO2) already has been studied, the effect on paraspinal oxygen saturation (rSpsO2) is still unexplored. This study aims to assess the effect of PE and E on rScO2 and rSpsO2, measured with near-infrared spectroscopy. A randomized 4-treatment cross-over trial was designed in 28 patients under BIS-titrated anaesthesia with sevoflurane. If MAP decreased more than 20% from baseline, incremental doses of PE and/or E were given according to the randomization (group I: E-PE-E, group II: PE-E-PE, group III: E-E-E, group IV: PE-PE-PE). rScO2 and rSpsO2 on T3-T4, T9-T10 and L1-L2 were recorded. Differences in rSO2 (post-pretreatment) within each group were analyzed with paired Student's t test. Differences in effects of PE and E on rScO2 and rSpsO2 were analyzed with linear mixed-modelling. Following PE administration, rScO2 decreased significantly (- 2.7% ± 3.5), while it remained stable following E (- 0.6% ± 3.6). Contrastingly, rSpsO2 at T3-T4, T9-T10 and L1-L2 slightly increased following PE (0.4% ± 2.5, 0.7% ± 2.0 and - 0.1% ± 1.4, respectively), while it decreased after E administration (- 1.3% ± 3.4%, - 0.7% ± 2.6% and - 1.3% ± 2.7%, respectively). Compared to E, PE administration was associated with a significant decrease in rScO2 (- 2.1%, 95% CI [- 3.1%, - 1.2%], p < 0.001). In contrast, compared to PE, E was associated with a significant decrease in rSpsO2 at T3-T4, T9-T10 and L1-L2 (- 2.0%, 95% CI [- 2.8, - 1.1], p < 0.001; - 1.4%, 95% CI [- 2.4%, - 0.4%], p = 0.006; and - 1.5%, 95% CI [- 2.3%, - 0.8%], p < 0.001, respectively). An opposite effect on rScO2 and rSpsO2 was observed after bolus administration of PE and E.
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Affiliation(s)
- Caroline M Vanpeteghem
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Bas Y Bruneel
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Isabeau M Lecoutere
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Stefan G De Hert
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Anneliese T Moerman
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Oostveen CN, Weerwind PW, Bergs PPE, Schmidli J, Bühlmann R, Schefold JC, Eberle B, Consiglio J, Schälte G, Kotelis D, Hollands AWH, Buhre WFFA, Schurink GWH, Jacobs MJ, van Mook WNKA, Mess WH, Sutedja NA. Neurophysiological and paraspinal oximetry monitoring to detect spinal cord ischemia in patients during and after descending aortic repair: An international multicenter explorative study. Contemp Clin Trials Commun 2020; 17:100545. [PMID: 32181411 PMCID: PMC7063092 DOI: 10.1016/j.conctc.2020.100545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/27/2020] [Accepted: 02/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background During descending aortic repair, critically decreased blood flow to the myelum can result in ischemic spinal cord injury and transient or permanent paraplegia. Assessment of motor evoked potentials (MEPs) has been shown to be a valuable tool which allows to detect spinal cord ischemia (SCI) intraoperatively within a therapeutic window suitable to prevent progression to paraparesis or paraplegia. MEP monitoring is not feasible during postoperative care in the awakening patient. Therefore, ancillary techniques to monitor integrity of spinal cord function are needed to detect delayed spinal cord ischemia. Objective The purpose of this study is to evaluate whether assessment of long loop reflexes (LLR; F-waves) and paraspinal muscle oximetry using Near-Infrared Spectroscopy (NIRS) are feasible and valid in detecting delayed SCI. Methods We aim to include patients from three tertiary referral centers undergoing aortic repair with MEP monitoring in this study. F-wave measurements and paraspinal NIRS oximetry will be operated intra- and postoperatively. Measurement characteristics and feasibility will be assessed in the first 25 patients. Subsequently, a second cohort of 75 patients will be investigated to determine the sensitivity and specificity of F-waves and NIRS in detecting perioperative SCI. In this context for the MEP group SCI is defined intraoperatively as significant MEP changes and postoperatively as newly developed paraplegia. Conclusions A clinical study design and protocol is proposed to assess if F-waves and/or NIRS-based paraspinal oximetry are feasible and valid in detecting and monitoring for occurrences of delayed SCI.
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Affiliation(s)
- Cheryl N Oostveen
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Patrick W Weerwind
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Paul P E Bergs
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Jürg Schmidli
- University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Roman Bühlmann
- University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Joerg C Schefold
- University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Balthasar Eberle
- University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Jolanda Consiglio
- University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Gereon Schälte
- Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Drosos Kotelis
- Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Angelique W H Hollands
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Wolfgang F F A Buhre
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Geert Willem H Schurink
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Michael J Jacobs
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands.,Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Walther N K A van Mook
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Werner H Mess
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Nadia A Sutedja
- Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
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Cheruku S, Huang N, Meinhardt K, Aguirre M. Anesthetic Management for Endovascular Repair of the Thoracic Aorta. Anesthesiol Clin 2019; 37:593-607. [PMID: 31677680 DOI: 10.1016/j.anclin.2019.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Thoracic endovascular aneurysm repair (TEVAR) is fast becoming the primary treatment of thoracic aortic aneurysms, thoracic aortic dissections, acute aortic injuries, and other conditions affecting the thoracic aorta. Patients scheduled for TEVAR tend to have a host of comorbid conditions, including coronary artery disease, diabetes, and chronic obstructive pulmonary disease. Intraoperative management should optimize end-organ perfusion, facilitate neuromonitoring, and adjust hemodynamic management. Complications include spinal cord injury, peripheral vascular injury, contrast-induced nephropathy, postimplantation syndrome, and endoleaks. Patients who undergo TEVAR require care in a postoperative environment where these complications can be rapidly detected and aggressively treated.
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Affiliation(s)
- Sreekanth Cheruku
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Mail Code 9068, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Norman Huang
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Mail Code 9068, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Kyle Meinhardt
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Mail Code 9068, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Marco Aguirre
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Mail Code 9068, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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32
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Rocha RV, Lindsay TF, Friedrich JO, Shan S, Sinha S, Yanagawa B, Al-Omran M, Forbes TL, Ouzounian M. Systematic review of contemporary outcomes of endovascular and open thoracoabdominal aortic aneurysm repair. J Vasc Surg 2019; 71:1396-1412.e12. [PMID: 31690525 DOI: 10.1016/j.jvs.2019.06.216] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/04/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of the study was to provide a systematic review of the literature reporting the contemporary early outcomes after endovascular and open repair of thoracoabdominal aortic aneurysms (TAAAs). METHODS MEDLINE and Embase were searched for studies from January 2006 to March 2018 that reported either endovascular (using branched or fenestrated endografts) or open repair of TAAA in at least 10 patients. Outcomes of interest included perioperative mortality, spinal cord injury (SCI), renal failure requiring dialysis, and stroke. Pooled proportions were determined using a random-effects model. RESULTS The analysis included 71 studies, of which 24 and 47 reported outcomes after endovascular and open TAAA repair, respectively. Endovascular cohort patients were older and had higher rates of coronary artery disease, chronic obstructive pulmonary disease, and diabetes. Endovascular repair was associated with higher rates of SCI (13.5%; 95% confidence interval [CI], 10.5%-16.7%) compared with open repair (7.4%; 95% CI, 6.2%-8.7%; P < .01) but similar rates of permanent paralysis (5.2% [95% CI, 3.8%-6.7%] vs 4.4% [95% CI, 3.3%-5.6%]; P = .39), lower rates of postoperative dialysis (6.4% [95% CI, 3.2%-9.5%] vs 12.0% [95% CI, 8.2%-16.3%]; P = .03) but similar rates of being discharged on permanent dialysis (3.7% [95% CI, 2.0%-5.9%] vs 3.8% [95% CI, 2.9%-5.3%]; P = .93), a trend to lower stroke (2.7% [95% CI, 1.9%-3.6%] vs 3.9% [95% CI, 3.0%-4.9%]; P = .06), and similar perioperative mortality (7.4% [95% CI, 5.9%-9.1%] vs 8.9% [95% CI, 7.2%-10.9%]; P = .21). CONCLUSIONS This systematic review summarizes the contemporary literature results of endovascular and open TAAA repair. Endovascular repair studies included patients with more comorbidities and were associated with higher rates of SCI but similar rates of permanent paraplegia, whereas open repair studies had higher rates of postoperative dialysis but similar rates of being discharged on permanent dialysis. Perioperative mortality rates were similar. Universally adopted reporting standards for patient characteristics, outcomes, and the conduct of contemporary comparative studies will allow better assessment and comparisons of the risks associated with the two surgical treatment options for TAAA.
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Affiliation(s)
- Rodolfo V Rocha
- Division of Cardiac Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas F Lindsay
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jan O Friedrich
- Critical Care and Medicine Departments and Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shubham Shan
- Division of Cardiac Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sidhartha Sinha
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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May near infra-red spectroscopy and rapid perfusion pressure recovering be enough to rule out post-operative spinal cord injury? Two compared case-reports. J Clin Monit Comput 2019; 34:955-959. [PMID: 31659652 DOI: 10.1007/s10877-019-00412-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
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Ghoreishi M, Coselli J. Commentary: Keep the head cool. Keep the spine cooler. J Thorac Cardiovasc Surg 2019; 160:44-45. [PMID: 31542176 DOI: 10.1016/j.jtcvs.2019.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Mehrdad Ghoreishi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Joseph Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex.
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Intraoperatives Monitoring in der konventionellen und endovaskulären Aortenchirurgie – Neue Verfahren. GEFÄSSCHIRURGIE 2019. [DOI: 10.1007/s00772-019-00562-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Vanpeteghem CM, Van de Moortel LMM, De Hert SG, Moerman AT. Assessment of Spinal Cord Ischemia With Near-Infrared Spectroscopy: Myth or Reality? J Cardiothorac Vasc Anesth 2019; 34:791-796. [PMID: 31399303 DOI: 10.1053/j.jvca.2019.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 11/11/2022]
Abstract
Non-invasive near-infrared spectroscopy is gaining popularity in the detection of spinal cord ischemia following aortic aneurysm repair. However, practical recommendations are lacking. This review focuses on the physiological and anatomical background, as well as on the clinical implementations of near-infrared spectroscopy as a tool for monitoring ischemia of the spinal cord. Clinical recommendations based on the currently available evidence are rendered.
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Affiliation(s)
- C M Vanpeteghem
- Department of Anesthesia and Perioperative Care, University Hospital Ghent, Ghent, Belgium.
| | - L M M Van de Moortel
- Department of Anesthesia and Perioperative Care, University Hospital Ghent, Ghent, Belgium
| | - S G De Hert
- Department of Anesthesia and Perioperative Care, University Hospital Ghent, Ghent, Belgium
| | - A T Moerman
- Department of Anesthesia and Perioperative Care, University Hospital Ghent, Ghent, Belgium
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Crestanello JA. Commentary: Toward safer aortic surgery: Monitoring spinal cord perfusion with near-infrared spectroscopy. J Thorac Cardiovasc Surg 2019; 158:165-166. [DOI: 10.1016/j.jtcvs.2018.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
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Evaluation of collateral network near-infrared spectroscopy during and after segmental artery occlusion in a chronic large animal model. J Thorac Cardiovasc Surg 2019; 158:155-164.e5. [DOI: 10.1016/j.jtcvs.2018.11.105] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/25/2018] [Accepted: 11/26/2018] [Indexed: 11/19/2022]
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Rashnavadi T, Macnab A, Cheung A, Shadgan A, Kwon BK, Shadgan B. Monitoring spinal cord hemodynamics and tissue oxygenation: a review of the literature with special focus on the near-infrared spectroscopy technique. Spinal Cord 2019; 57:617-625. [PMID: 31164734 DOI: 10.1038/s41393-019-0304-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 01/05/2023]
Abstract
STUDY DESIGN Review. OBJECTIVES Clinical studies have shown that the hemodynamic management of patients following acute spinal cord injury (SCI) is an important aspect of their treatment for maintaining spinal cord (SC) perfusion and minimizing ischemic secondary injury to the SC. While this highlights the importance of ensuring adequate perfusion and oxygenation to the injured cord, a method for the real-time monitoring of these hemodynamic measures within the SC is lacking. The purpose of this review is to discuss current and potential methods for SC hemodynamic monitoring with special focus on applications using near-infrared spectroscopy (NIRS). METHODS A literature search using the PubMed database. All peer-reviewed articles on NIRS monitoring of SC published from inception to May 2019 were reviewed. RESULTS Among 125 papers related to SC hemodynamics monitoring, 26 focused on direct/indirect NIRS monitoring of the SC. DISCUSSION Current options for continuous, non-invasive, and real-time monitoring of SC hemodynamics are challenging and limited in scope. As a relatively new technique, NIRS has been successfully used for monitoring human cerebral hemodynamics, and has shown promising results in intraoperative assessment of SC hemodynamics in both human and animal models. Although utilizing NIRS to monitor the SC has been validated, applying NIRS clinically following SCI requires further development and investigation. CONCLUSIONS NIRS is a promising non-invasive technique with the potential to provide real-time monitoring of relevant parameters in the SC. Currently, in its first developmental stages, further clinical and experimental studies are mandatory to ensure the validity and safety of NIRS techniques.
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Affiliation(s)
- Tahereh Rashnavadi
- The University of British Columbia, School of Biomedical Engineering, Vancouver, BC, V6T 1Z1, Canada
| | - Andrew Macnab
- International Collaborations on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, Vancouver, Canada
| | - Amanda Cheung
- International Collaborations on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, Vancouver, Canada
| | - Armita Shadgan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Brian K Kwon
- International Collaborations on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, Vancouver, Canada.,Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Babak Shadgan
- The University of British Columbia, School of Biomedical Engineering, Vancouver, BC, V6T 1Z1, Canada. .,International Collaborations on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, Vancouver, Canada. .,Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada.
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Outcomes After Thoracic Endovascular Aortic Repair With Overstenting of the Left Subclavian Artery. Ann Thorac Surg 2019; 107:1372-1379. [DOI: 10.1016/j.athoracsur.2018.10.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/25/2018] [Accepted: 10/16/2018] [Indexed: 11/17/2022]
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Fujiyoshi T, Nishibe T, Koizumi N, Kano M, Suzuki S, Iwahori A, Maruno K, Kawago K, Takahashi S, Iwahashi T, Kamiya K, Ogino H. Impact of preservation of the latissimus dorsi muscle through a left anteroaxillary thoracotomy on spinal cord protection in descending thoracic and thoraco-abdominal aortic operations†. Eur J Cardiothorac Surg 2019; 56:ezz087. [PMID: 30897202 DOI: 10.1093/ejcts/ezz087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVES The presence of collateral network circulation to the spinal cord, which is reflected in the repair of a descending thoracic aortic aneurysm (dAo) and a thoraco-abdominal aortic aneurysm (TAAo), has been demonstrated in clinical and animal experimental data. The latissimus dorsi muscle (LDM) including the thoracodorsal artery might be one of the major sources of this collateral network. The objective of this study was to evaluate the impact on spinal cord safety of a left anteroaxillary thoracotomy with minimal muscle division including preservation of the LDM in surgery for dAo and TAAo. METHODS Sixty-nine patients [64 (23-85) years old; 56 men] who underwent surgical repair for dAo and TAAo were divided into 2 groups: 29 [65 (23-84) years old] with an anteroaxillary thoracotomy with LDM preservation (PL group) and 40 [61 (28-85) years old] with a lateral thoracotomy without LDM preservation (NL group). RESULTS Aortic repairs were performed at the dAo in 30 patients including 14 in the PL group vs 16 in the NL group and at the TAAo in 39 patients including 15 in the PL group vs 24 in the NL group. There were 2 (2.9%) 30-day deaths; 2 (7.9%) in the PL group vs none in the NL group (P = 0.173). No strokes occurred. In patients with a femoro-femoral partial cardiopulmonary bypass with mild hypothermia, the incidence of loss of signal of motor-evoked potentials (>50%) was significantly lower in the PL group; 5.6% vs 31.8% (P = 0.039). The frequency of signal reduction of the remaining motor-evoked potential after surgery was also significantly lower in the PL group: 3.7% vs 25% (P = 0.040). Subsequently, the rate of spinal cord complications were lower in the PL group: 3.4% vs 12.5% (P = 0.188). CONCLUSIONS The left anteroaxillary thoracotomy with minimal incision of the muscles including the LDM might have potential advantages for spinal cord protection via preserved intramuscular collateral circulations to the spinal cord in dAo/TAAo open repairs.
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Affiliation(s)
- Toshiki Fujiyoshi
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Nobusato Koizumi
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masaki Kano
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Shun Suzuki
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Akinari Iwahori
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Keta Maruno
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Koji Kawago
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Satoshi Takahashi
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kentarou Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
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Spinal cord perfusion protection for thoraco-abdominal aortic aneurysm surgery. Curr Opin Anaesthesiol 2019; 32:72-79. [DOI: 10.1097/aco.0000000000000670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Parotto M, Ouzounian M, Djaiani G. Spinal Cord Protection in Elective Thoracoabdominal Aortic Procedures. J Cardiothorac Vasc Anesth 2019; 33:200-208. [DOI: 10.1053/j.jvca.2018.05.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Indexed: 11/11/2022]
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Tenorio ER, Eagleton MJ, Kärkkäinen JM, Oderich GS. Prevention of spinal cord injury during endovascular thoracoabdominal repair. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60. [DOI: 10.23736/s0021-9509.18.10739-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Tanaka A, Safi HJ, Estrera AL. Current strategies of spinal cord protection during thoracoabdominal aortic surgery. Gen Thorac Cardiovasc Surg 2018; 66:307-314. [DOI: 10.1007/s11748-018-0906-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
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von Aspern K, Bakhtiary F, Misfeld M, Mohr FW, Etz CD. Paraspinale Nahinfrarotspektroskopie zur indirekten Überwachung der Rückenmarkoxygenierung. GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00772-017-0244-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dias-Neto M, Reis PV, Rolim D, Ramos JF, Teixeira JF, Sampaio S. Strategies to prevent TEVAR-related spinal cord ischemia. Vascular 2016; 25:307-315. [DOI: 10.1177/1708538116671235] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Spinal cord ischemia remains the Achilles’ heel of thoracic and thoracoabdominal diseases management. Great improvements in morbidity and mortality have been obtained with the endovascular approach TEVAR (Thoracic Endovascular Aortic Repair) but this devastating complication continues to severely affect the quality of life, even if the primary success of the procedure – dissection/aneurysm exclusion – has been achieved. Several strategies to deal with this complication have been published in the literature over the time. Knowledge and technology have been evolving from identification of the risk factors associated with spinal cord ischemia, including lessons learned from open surgery, and from developments in the collateral network concept for spinal cord perfusion. In this comprehensive review, the authors cover several topics from the traditional measures comprising haemodynamic control, cerebrospinal drainage and neuroprotective drugs, to the staged-procedures approach, the emerging MISACE (minimally invasive selective segmental artery coil-embolization) and innovative neurologic monitoring such as NIRS (near-infrared spectroscopy) of the collateral network.
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Affiliation(s)
- Marina Dias-Neto
- Department of Angiology and Vascular Surgery, São João Hospital Center, Alameda Professor Hernani Monteiro, Portugal
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Alameda Professor Hernani Monteiro, Portugal
| | - Pedro Videira Reis
- Department of Anaesthesiology, São João Hospital Center, Alameda Professor Hernani Monteiro, Portugal
| | - Dalila Rolim
- Department of Angiology and Vascular Surgery, São João Hospital Center, Alameda Professor Hernani Monteiro, Portugal
| | - José Fernando Ramos
- Department of Angiology and Vascular Surgery, São João Hospital Center, Alameda Professor Hernani Monteiro, Portugal
| | - José Fernando Teixeira
- Department of Angiology and Vascular Surgery, São João Hospital Center, Alameda Professor Hernani Monteiro, Portugal
| | - Sérgio Sampaio
- Department of Angiology and Vascular Surgery, São João Hospital Center, Alameda Professor Hernani Monteiro, Portugal
- Faculty of Medicine, Department of Information and Decision Sciences in Health (CIDES), Research Center in Health Technologies and Information systems (CINTESIS), University of Porto, Alameda Professor Hernani Monteiro, Portugal
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Lindsay H, Srinivas C, Djaiani G. Neuroprotection during aortic surgery. Best Pract Res Clin Anaesthesiol 2016; 30:283-303. [DOI: 10.1016/j.bpa.2016.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 04/21/2016] [Accepted: 05/09/2016] [Indexed: 01/16/2023]
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Suehiro K, Funao T, Fujimoto Y, Mukai A, Nakamura M, Nishikawa K. Transcutaneous near-infrared spectroscopy for monitoring spinal cord ischemia: an experimental study in swine. J Clin Monit Comput 2016; 31:975-979. [DOI: 10.1007/s10877-016-9931-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 08/24/2016] [Indexed: 11/30/2022]
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50
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Grus T, Lambert L, Rohn V, Klika T, Grusová G, Michálek P. Juxtarenal Mycotic Aneurysm as a Complication of Acute Exacerbation of Chronic Cholecystitis Treated by Resection and Replacement by a Fresh Allograft. Prague Med Rep 2016; 117:54-60. [PMID: 26995203 DOI: 10.14712/23362936.2016.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
We present a case of a female patient with infectious (mycotic) juxtarenal abdominal aneurysm with atypical symptoms beginning as acute exacerbation of chronic cholecystitis. Apart from common antibiotic treatment, the patient successfully underwent resection of the diseased segment and replacement by a fresh allograft in order to reduce the risk of infection of the graft, but with the need of subsequent life-long immunosuppressive therapy. Perioperative monitoring of the spinal cord by near infrared spectroscopy was used to identify possible spinal ischemia. The choice of the fresh allograft was based on our experience supported by review of the literature.
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Affiliation(s)
- Tomáš Grus
- 2nd Department of Surgery - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Lukáš Lambert
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
| | - Vilém Rohn
- 2nd Department of Surgery - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Tomáš Klika
- 2nd Department of Surgery - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Gabriela Grusová
- 4th Department of Medicine - Department of Gastroenterology and Hepatology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Michálek
- Department of Anaesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
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