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Saitoh D, Yamazaki Y, Tsuji T, Sakoda N, Yakuwa K, Tabayashi A, Koizumi J, Ohsawa S, Kin H. Patterns of collateral arteries to the spinal cord after thoraco-abdominal aortic aneurysm repair. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae087. [PMID: 38696750 PMCID: PMC11193310 DOI: 10.1093/icvts/ivae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/30/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES Our goal was to evaluate postoperative patterns of collateral arteries to the spinal cord during occlusion of the segmental arteries supplying the artery of Adamkiewicz (AKA). METHODS Between April 2011 and December 2022, a total of 179 patients underwent thoraco-abdominal aortic aneurysm repair; 141 had an identifiable AKA on preoperative multidetector computed tomography scans, 40 underwent thoraco-abdominal aortic aneurysm replacement (TAAR) and 101 underwent thoracic endovascular aortic repair (TEVAR). New postoperative collateral blood pathways invisible on preoperative contrast-enhanced computed tomography scans were identified in 42 patients (10 patients who had TAAR vs 32 patients who had TEVAR) who underwent preoperative and postoperative multidetector computed tomography scanning for AKA identification. RESULTS The thoracodorsal and segmental arteries were the main collateral pathways in both groups. Th9-initiated collaterals were the most common. Collaterals from the internal thoracic artery were observed in the TEVAR group but not in the TAAR group. One patient in the TEVAR group experienced postoperative paraparesis, which was not observed in the TAAR group. Postoperative paraplegia was more common in the non-Th9-origin group, but this difference was not significant. CONCLUSIONS Thoracodorsal and segmental arteries may be important collateral pathways after TEVAR and TAAR. For thoracodorsal arteries, preserving the thoracodorsal muscle during the approach would be crucial; for segmental arteries, minimizing the area to be replaced or covered would be paramount. An AKA not initiated at the Th9 level poses a high risk of postoperative paraplegia.
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Affiliation(s)
- Daiki Saitoh
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
| | - Yuya Yamazaki
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
| | - Tatsunori Tsuji
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
| | - Naoya Sakoda
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
| | - Kazuki Yakuwa
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
| | - Azuma Tabayashi
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
| | - Junichi Koizumi
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
| | - Satoshi Ohsawa
- Department of Cardiovascular Surgery, San-ai Hospital, Iwate, Japan
| | - Hajime Kin
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
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2
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Ando M, Kise Y, Kuniyoshi Y, Higa S, Nagano T, Furukawa K. Usefulness of Motor Evoked Potential Measurement and Analysis of Risk Factors for Spinal Cord Ischaemia from 300 Cases of Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00259-4. [PMID: 38499146 DOI: 10.1016/j.ejvs.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 02/22/2024] [Accepted: 03/15/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE This study investigated the usefulness of motor evoked potentials (MEPs) for intra-operative monitoring to detect the risk of spinal cord ischaemia (SCI) during thoracic endovascular aortic repair (TEVAR). Risk factors for SCI in TEVAR were also analysed. METHODS Among 330 TEVARs performed from February 2009 to October 2018, 300 patients underwent intra-operative MEP monitoring. SCI risk groups were extracted based on MEP amplitude changes using a cutoff value of 50%. When the amplitude decreased to < 50% of the pre-operative value, intra-operative mean arterial pressure (MAP) was increased by about 20 mmHg using noradrenaline, whereas MAP was usually controlled to about 80 mmHg during surgery. Other efforts were also made to increase MEP amplitude by increasing cardiac output, correcting anaemia, and finishing the surgery promptly. Based on MEP amplitude data, SCI risk groups were extracted and risk factors for SCI in TEVAR were analysed. RESULTS A total of 283 non-SCI risk patients and 17 SCI risk patients by MEP monitoring were extracted; only 1.0% developed immediate paraplegia and none developed delayed paraplegia. Bivariable analysis showed significant differences in chronic kidney disease, haemodialysis, artery of Adamkiewicz closure, and stent graft (SG) covered length ≥ 8 vertebral bodies. Logistic regression analysis showed hyperlipidaemia (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.08 - 11.67; p = .037), SG covered length ≥ 8 vertebral bodies (OR 1.35, 95% CI 1.02 - 1.78; p = .034), and haemodialysis (OR 27.78, 95% CI 6.02 - 128.22; p < .001) were the most influential risk factors for SCI in TEVAR. CONCLUSION MEPs might be a useful monitoring tool to predict SCI in TEVAR. In addition, hyperlipidaemia, SG covered length ≥ 8 vertebral bodies, and haemodialysis represent key risk factors for SCI during TEVAR.
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Affiliation(s)
- Mizuki Ando
- Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, Nishihara, Okinawa, Japan.
| | - Yuya Kise
- Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Yukio Kuniyoshi
- Department of Cardiovascular Surgery, Urasoe General Hospital, Urasoe, Okinawa, Japan
| | - Shotaro Higa
- Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Takaaki Nagano
- Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Kojiro Furukawa
- Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, Nishihara, Okinawa, Japan
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3
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Herajärvi J, Juvonen T. Preparing the spinal cord - priming or preconditioning? A systematic review of experimental studies. Scand Cardiovasc J Suppl 2023; 57:2166100. [PMID: 36660818 DOI: 10.1080/14017431.2023.2166100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives. Paraplegia is devastating complication associated with thoracic and thoracoabdominal aortic aneurysm repair. Vast evidence has been gathered on pre-, peri- and postoperative protective adjuncts aiming to minimize spinal cord ischemia. This review focuses on the pretreatment phase of open surgical or endovascular aortic procedures and gathers the experimental data on the interventional preconditioning and priming methods that increase the spinal cord ischemic tolerance. Design. By the start of March 2021, a systematic review was performed in PubMed, Scopus and Web of Science core collection to identify the articles that reported (i) either an ischemic preconditioning, remote ischemic preconditioning or priming method prior to (ii) experimental spinal cord ischemia performed in endovascular or open surgical fashion mimicking either thoracic, abdominal or thoracoabdominal aortic aneurysm procedures. (iii) The outcomes were reported via neurological, motor-evoked potential, somatosensory-evoked potential, histopathological, immunohistochemical, physiological analysis, or in different combinations of these measurements. Results. The search yielded 7802 articles, and 57 articles were included in the systematic review. The articles were assessed by the evaluated species, the utilized pretreatment, the measured protective effects, and the suggested underlying mechanisms. Conclusions. The reviewed articles showed several possible mechanisms in ischemic and remote ischemic preconditioning for prevention of spinal cord ischemia. The main suggested method for priming was arteriogenetic stimulus. Future studies should confirm these hints of arteriogenetic stimulus with more precise quantification of the protective recruitment process.
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Affiliation(s)
- Johanna Herajärvi
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
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4
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Amabile A, Lewis E, Costa V, Tadros RO, Han DK, Di Luozzo G. Spinal cord protection in open and endovascular approaches to thoracoabdominal aortic aneurysms. Vascular 2023; 31:874-883. [PMID: 35507464 DOI: 10.1177/17085381221094411] [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] [Indexed: 11/16/2022]
Abstract
Despite advancements in surgical and postoperative management, spinal cord injury has been a persistent complication of both open and endovascular repair of thoracoabdominal and descending thoracic aortic aneurysm. Spinal cord injury can be explained with an ischemia-infarction model which results in local edema of the spinal cord, damaging its structure and leading to reversible or irreversible loss of its function. Perfusion of the spinal cord during aortic procedures can be enhanced by several adjuncts which have been described with a broad variety of evidence in their support. These adjuncts include systemic hypothermia, cerebrospinal fluid drainage, extracorporeal circulation and distal aortic perfusion, segmental arteries reimplantation, left subclavian artery revascularization, and staged aortic repair. The Authors here reviewed and discussed the role of such adjuncts in preventing spinal cord injury from occurring, pinpointing current evidence and outlining future perspectives.
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Affiliation(s)
- Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Erin Lewis
- Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Victor Costa
- Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Rami O Tadros
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel K Han
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gabriele Di Luozzo
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ohira S, Lansman SL, Spielvogel D. Collateral network concept in 2023. Ann Cardiothorac Surg 2023; 12:450-462. [PMID: 37817844 PMCID: PMC10561329 DOI: 10.21037/acs-2023-scp-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/10/2023] [Indexed: 10/12/2023]
Abstract
Extensive thoracoabdominal aortic aneurysm repair can cause spinal cord ischemia which significantly impacts survival and quality of life. Although this complication is uncommon, it is important to recognize the pathophysiology and preventative measures. In the 1990s, Dr. Griepp and colleagues proposed the existence of an extensive collateral network that supports spinal cord perfusion, "the collateral network concept". This includes an interconnecting complex of vessels in the intraspinal, paraspinous, and epidural spaces, and in the paravertebral muscles, involving the intercostal and lumbar segmental arteries as well as the subclavian and hypogastric (iliac) arteries. In this concept, as opposed to the one major segmental input model such as the Adamkiewicz artery, recognition of the importance of multiple inputs to the spinal circulation is paramount to maintaining the spinal blood flow and preventing spinal cord ischemia. In this article, we review the current evidence of the collateral concept and its application in aortic surgery.
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Affiliation(s)
- Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Steven L Lansman
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Rosati C, Di Luozzo G. Commentary: A conceptual roadmap to spinal cord protection in thoracoabdominal aortic surgery. JTCVS Tech 2021; 8:18-19. [PMID: 34401796 PMCID: PMC8350601 DOI: 10.1016/j.xjtc.2021.02.013] [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: 02/03/2021] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Carlo Rosati
- Icahn School of Medicine at Mount Sinai, New York, NY
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Shijo T, Kuratani T, Shimamura K, Kin K, Masada K, Goto T, Ide T, Takahara M, Sawa Y. Extrathoracic collaterals to critical segmental arteries after endovascular thoraco-abdominal aneurysm repair. Interact Cardiovasc Thorac Surg 2020; 30:932-939. [PMID: 32150275 DOI: 10.1093/icvts/ivaa024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/13/2020] [Accepted: 01/22/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The risk of spinal cord injury after thoraco-abdominal aortic aneurysm repair increases when the segmental arteries (SAs) in the critical segment are sacrificed. Such critical SAs cannot be reconstructed when performing thoracic endovascular aortic repair (TEVAR). We aimed to elucidate extrathoracic collaterals to the critical SAs (T9-L1) that develop after TEVAR. METHODS Between 2006 and 2018, the critical SAs (T9-L1) of 38 patients were sacrificed during TEVAR. Nineteen of these patients who underwent multidetector row computed tomography 6 months after surgery were included (mean age 60 ± 13 years; 10 male; Crawford extent II:III, 14:5). We retrospectively assessed extrathoracic collaterals to the sacrificed critical SAs. RESULTS Ninety-four collaterals to the critical SAs were observed, originating from the subclavian (26/94), external iliac (50/94) and internal iliac (18/94) arteries. Twenty-five of the 26 (96%) collaterals from the subclavian artery were from its lateral descending branch, and 19 of the 26 (73%) collaterals fed into T9. Forty-three of the 50 (86%) collaterals from the external iliac artery were from its lateral ascending branch, and 25 of the 50 (50%) collaterals communicated with T11. Patients with a history of left thoracotomy (no collaterals in 6 patients) had fewer collaterals via the lateral descending branch of the left subclavian artery in comparison with the patients without (10 collaterals in 13 patients) (P = 0.009). CONCLUSIONS After critical SAs were sacrificed, extrathoracic collaterals developed with certain regularity. Previous left thoracotomy could influence the development of extrathoracic collaterals from the left subclavian artery.
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Affiliation(s)
- Takayuki Shijo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuo Shimamura
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keiwa Kin
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenta Masada
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takasumi Goto
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toru Ide
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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8
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Kise Y, Kuniyoshi Y, Ando M, Maeda T, Inafuku H, Yamashiro S. Transapical aortic perfusion using a deep hypothermic procedure during descending thoracic or thoracoabdominal aortic surgery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:749-754. [PMID: 31640318 DOI: 10.23736/s0021-9509.19.11043-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm (TAAA) surgery, though proximal anastomosis using deep hypothermic circulatory arrest (DHCA) is often selected, there are issues surrounding brain and heart protection. In this study, the usefulness of concomitant upper body perfusion via transapical aortic cannulation during deep hypothermic surgery was examined. METHODS Between October 2014 and May 2019, 5 patients (Crawford extent II chronic dissection, N.=3; extent IV aneurysms, N.=1; DTAA, N.=1) underwent DTAA/TAAA repair under deep hypothermia using transapical aortic perfusion. A proximal anastomosis and artery of Adamkiewicz (AKA) reconstruction were performed under continuous perfusion of the upper and lower body at 20 °C. RESULTS The time from aortic cross-clamping to proximal anastomosis was 69±33 minutes, and it took 86±47 minutes to AKA reperfusion. There was no spinal cord ischemic injury or brain or heart complications. One patient required tracheostomy, and the average postoperative intubation time for the other patients was 57±52 hours. All patients were discharged, and the average postoperative hospital stay was 25.6±8.1 days. CONCLUSIONS Concomitant upper body perfusion by the transapical aortic approach contributes to avoidance of brain and heart complications and maintaining spinal cord circulation under deep hypothermic DTAA/TAAA surgery.
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Affiliation(s)
- Yuya Kise
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan -
| | - Yukio Kuniyoshi
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Mizuki Ando
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tatuya Maeda
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hitoshi Inafuku
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Satoshi Yamashiro
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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9
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Bignami E, Di Lecce M, Baciarello M, Bellini V, Fanelli M, D'Ospina RM, Perini P, Freyrie A. Direct Intraoperative Neurologic Assessment to Monitor Spinal Cord Ischemia During Thoracoabdominal Aneurysm Endovascular Repair. J Cardiothorac Vasc Anesth 2019; 33:2775-2780. [PMID: 30898423 DOI: 10.1053/j.jvca.2019.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Marco Di Lecce
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Baciarello
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mara Fanelli
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Rita Maria D'Ospina
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Paolo Perini
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
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10
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Transapical aortic perfusion using a deep hypothermic procedure to prevent dissecting lung injury during re-do thoracoabdominal aortic aneurysm surgery. J Cardiothorac Surg 2017; 12:32. [PMID: 28526092 PMCID: PMC5437642 DOI: 10.1186/s13019-017-0601-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Avoiding various complications is a challenge during re-do thoracoabdominal aneurysm surgery. CASE PRESENTATION A 56-year-old man had undergone surgery for type I aortic dissection four times. The residual thoracoabdominal aortic aneurysm that had severe adhesions to lung parenchyma was resected. Since the proximal anastomotic site was buried in lung parenchyma, deep hypothermia was essential to avoid lung dissection and to protect the spinal cord during the proximal anastomosis. The deep hypothermia was induced with bilateral infusion of cardiopulmonary bypass by femoral artery cannulation for the lower body and by transapical cannulation for the upper body because of easy access. There was no hemorrhagic tendency after deep hypothermic bypass. The patient was discharged uneventfully. CONCLUSIONS For upper body perfusion, transapical aortic cannulation was a simple and effective procedure during left thoracotomy.
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11
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Mangialardi N, Lachat M, Esposito A, Puippe G, Orrico M, Alberti V, Fazzini S, Ronchey S. The “Open Branch” Technique. Catheter Cardiovasc Interv 2015; 87:773-80. [DOI: 10.1002/ccd.26373] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/09/2015] [Accepted: 11/22/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | - Mario Lachat
- Clinic for Cardiovascular Surgery; University Hospital of Zurich; Zurich
| | - Andrea Esposito
- Vascular Surgery Department; San Filippo Neri Hospital; Rome
| | - Gilberte Puippe
- Clinic for Cardiovascular Surgery; University Hospital of Zurich; Zurich
| | - Matteo Orrico
- Vascular Surgery Department; San Filippo Neri Hospital; Rome
| | | | - Stefano Fazzini
- Vascular Surgery Department; San Filippo Neri Hospital; Rome
| | - Sonia Ronchey
- Vascular Surgery Department; San Filippo Neri Hospital; Rome
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12
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Seco M, Edelman JJB, Van Boxtel B, Forrest P, Byrom MJ, Wilson MK, Fraser J, Bannon PG, Vallely MP. Neurologic injury and protection in adult cardiac and aortic surgery. J Cardiothorac Vasc Anesth 2015; 29:185-95. [PMID: 25620144 DOI: 10.1053/j.jvca.2014.07.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Michael Seco
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - J James B Edelman
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Benjamin Van Boxtel
- Columbia University Medical Center-New York Presbyterian Hospital, New York, New York
| | - Paul Forrest
- Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael J Byrom
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael K Wilson
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Paul G Bannon
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael P Vallely
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
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13
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Repeated total en bloc spondylectomy for spinal metastases at different sites in one patient. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:2196-200. [DOI: 10.1007/s00586-015-4091-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/24/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
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14
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Griepp RB, Griepp EB. Spinal cord protection in surgical and endovascular repair of thoracoabdominal aortic disease. J Thorac Cardiovasc Surg 2015; 149:S86-90. [DOI: 10.1016/j.jtcvs.2014.10.056] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 09/29/2014] [Accepted: 10/06/2014] [Indexed: 11/16/2022]
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15
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Directly measuring spinal cord blood flow and spinal cord perfusion pressure via the collateral network: Correlations with changes in systemic blood pressure. J Thorac Cardiovasc Surg 2015; 149:360-6. [DOI: 10.1016/j.jtcvs.2014.09.121] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 09/11/2014] [Accepted: 09/14/2014] [Indexed: 11/22/2022]
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Commentary on "Temporary aneurysm sac perfusion as an adjunct for prevention of spinal cord ischaemia after branched endovascular repair of thoracoabdominal aneurysms". Eur J Vasc Endovasc Surg 2014; 48:266-7. [PMID: 25023001 DOI: 10.1016/j.ejvs.2014.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/16/2014] [Indexed: 11/23/2022]
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17
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Geisbüsch S, Stefanovic A, Koruth JS, Lin HM, Morgello S, Weisz DJ, Griepp RB, Di Luozzo G. Endovascular coil embolization of segmental arteries prevents paraplegia after subsequent thoracoabdominal aneurysm repair: an experimental model. J Thorac Cardiovasc Surg 2013; 147:220-6. [PMID: 24220154 DOI: 10.1016/j.jtcvs.2013.09.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/04/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To test a strategy for minimizing ischemic spinal cord injury after extensive thoracoabdominal aneurysm (TAAA) repair, we occluded a small number of segmental arteries (SAs) endovascularly 1 week before simulated aneurysm repair in an experimental model. METHODS Thirty juvenile Yorkshire pigs (25.2 ± 1.7 kg) were randomized into 3 groups. All SAs, both intercostal and lumbar, were killed by a combination of surgical ligation of the lumbar SAs and occlusion of intercostal SAs with thoracic endovascular stent grafting. Seven to 10 days before this simulated TAAA replacement, SAs in the lower thoracic/upper lumbar region were occluded using embolization coils: 1.5 ± 0.5 SAs in group 1 (T13/L1), and 4.5 ± 0.5 SAs in group 2 (T11-L3). No SAs were coiled in the controls. Hind limb function was evaluated blindly from daily videotapes using a modified Tarlov score (0 = paraplegia, 9 = full recovery). After death, each segment of spinal cord was graded histologically using the 9-point Kleinman score (0 = normal, 8 = complete necrosis). RESULTS Hind limb function remained normal after coil embolization. After simulated TAAA repair, paraplegia occurred in 6 of 10 control pigs, but in only 2 of 10 pigs in group 1; no pigs in group 2 had a spinal cord injury. Tarlov scores were significantly better in group 2 (control vs group 1, P = .06; control vs group 2, P = .0002; group 1 vs group 2, P = .05). A dramatic reduction in histologic damage, most prominently in the coiled region, was seen when SAs were embolized before simulated TAAA repair. CONCLUSIONS Endovascular coiling of 2 to 4 SAs prevented paraplegia in an experimental model of extensive hybrid TAAA repair, and helped protect the spinal cord from ischemic histopathologic injury. A clinical trial in a selected patient population at high risk for postoperative spinal cord injury may be appropriate.
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Affiliation(s)
- Sarah Geisbüsch
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY.
| | - Angelina Stefanovic
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY
| | - Jacob S Koruth
- Department of Cardiology, Mount Sinai Medical Center, New York, NY
| | - Hung-Mo Lin
- Department of Health Evidence and Policy, Mount Sinai Medical Center, New York, NY
| | - Susan Morgello
- Department of Neuropathology, Mount Sinai Medical Center, New York, NY
| | - Donald J Weisz
- Department of Neurology, Mount Sinai Medical Center, New York, NY
| | - Randall B Griepp
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY
| | - Gabriele Di Luozzo
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY
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Appoo JJ, Tse LW, Pozeg ZI, Wong JK, Hutchison SJ, Gregory AJ, Herget EJ. Thoracic aortic frontier: review of current applications and directions of thoracic endovascular aortic repair (TEVAR). Can J Cardiol 2013; 30:52-63. [PMID: 24365190 DOI: 10.1016/j.cjca.2013.10.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 10/10/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022] Open
Abstract
Thoracic endovascular aortic repair, a minimally invasive technique is replacing the maximally invasive gold standard of thoracotomy and replacement of the descending thoracic aorta. With experience, indications have expanded to encroach on the arch and even ascending aorta. This review highlights the current state of technology, discusses controversies, and takes the perspective of a forward-thinking review to describe novel, innovative techniques that might make the entire thoracic aorta amenable to minimally invasive repair.
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Affiliation(s)
- Jehangir J Appoo
- Division of Cardiac Surgery, Libin Cardiovascular Institute, Department of Cardiac Sciences and Surgery, University of Calgary, Calgary, Alberta, Canada.
| | - Leonard W Tse
- Division of Vascular Surgery, Toronto General Hospital, PMCC, UHN, University of Toronto, Toronto, Ontario, Canada
| | - Zlatko I Pozeg
- Division of Cardiac Surgery, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason K Wong
- Division of Interventional Radiology, Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Stuart J Hutchison
- Division of Cardiology, Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alex J Gregory
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Anaesthesiology, University of Calgary, Calgary, Alberta, Canada
| | - Eric J Herget
- Division of Interventional Radiology, Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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19
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Cantinieaux D, Quertainmont R, Blacher S, Rossi L, Wanet T, Noël A, Brook G, Schoenen J, Franzen R. Conditioned medium from bone marrow-derived mesenchymal stem cells improves recovery after spinal cord injury in rats: an original strategy to avoid cell transplantation. PLoS One 2013; 8:e69515. [PMID: 24013448 PMCID: PMC3754952 DOI: 10.1371/journal.pone.0069515] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/10/2013] [Indexed: 12/11/2022] Open
Abstract
Spinal cord injury triggers irreversible loss of motor and sensory functions. Numerous strategies aiming at repairing the injured spinal cord have been studied. Among them, the use of bone marrow-derived mesenchymal stem cells (BMSCs) is promising. Indeed, these cells possess interesting properties to modulate CNS environment and allow axon regeneration and functional recovery. Unfortunately, BMSC survival and differentiation within the host spinal cord remain poor, and these cells have been found to have various adverse effects when grafted in other pathological contexts. Moreover, paracrine-mediated actions have been proposed to explain the beneficial effects of BMSC transplantation after spinal cord injury. We thus decided to deliver BMSC-released factors to spinal cord injured rats and to study, in parallel, their properties in vitro. We show that, in vitro, BMSC-conditioned medium (BMSC-CM) protects neurons from apoptosis, activates macrophages and is pro-angiogenic. In vivo, BMSC-CM administered after spinal cord contusion improves motor recovery. Histological analysis confirms the pro-angiogenic action of BMSC-CM, as well as a tissue protection effect. Finally, the characterization of BMSC-CM by cytokine array and ELISA identified trophic factors as well as cytokines likely involved in the beneficial observed effects. In conclusion, our results support the paracrine-mediated mode of action of BMSCs and raise the possibility to develop a cell-free therapeutic approach.
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Affiliation(s)
- Dorothée Cantinieaux
- GIGA-Neuroscience, Axonal Regeneration and Cephalic Pain Unit, University of Liege, Liege, Belgium
| | - Renaud Quertainmont
- GIGA-Neuroscience, Axonal Regeneration and Cephalic Pain Unit, University of Liege, Liege, Belgium
| | - Silvia Blacher
- GIGA-Cancer, Laboratory of Biology of Tumour and Development, University of Liege, Liege, Belgium
| | - Loïc Rossi
- GIGA-Neuroscience, Axonal Regeneration and Cephalic Pain Unit, University of Liege, Liege, Belgium
| | - Thomas Wanet
- GIGA-Neuroscience, Axonal Regeneration and Cephalic Pain Unit, University of Liege, Liege, Belgium
| | - Agnès Noël
- GIGA-Cancer, Laboratory of Biology of Tumour and Development, University of Liege, Liege, Belgium
| | - Gary Brook
- Department of Neuropathology, University of Aachen, Aachen, Germany
| | - Jean Schoenen
- GIGA-Neuroscience, Axonal Regeneration and Cephalic Pain Unit, University of Liege, Liege, Belgium
| | - Rachelle Franzen
- GIGA-Neuroscience, Axonal Regeneration and Cephalic Pain Unit, University of Liege, Liege, Belgium
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20
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Griepp EB, Di Luozzo G, Schray D, Stefanovic A, Geisbüsch S, Griepp RB. The anatomy of the spinal cord collateral circulation. Ann Cardiothorac Surg 2013; 1:350-7. [PMID: 23977520 DOI: 10.3978/j.issn.2225-319x.2012.09.03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 09/06/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Eva B Griepp
- Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York, USA
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21
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Coselli JS. Update on repairs of the thoracoabdominal aorta. Tex Heart Inst J 2013; 40:572-574. [PMID: 24391325 PMCID: PMC3853816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine; and Texas Heart Institute; Houston, Texas 77030
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