Spinal cord retrograde perfusion: Review of the literature and experimental observations

Marco Pocar, Vincenzo Rossi, Alessandro Addis, Ario Monaco, Sergio Sichel, Flaminio Addis, Adalberto Grossi, Francesco Donatelli

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Spinal cord damage represents a devastating complication of thoracic and thoracoabdominal aortic surgery. Retrograde perfusion as an alternative route to protect the spinal cord has recently been investigated with controversial results. We reviewed the literature and analyzed additional experimental observations. Methods: Ten juvenile pigs were divided into control and study groups (A and B, respectively). Through a lateral thoracotomy the distal aortic arch was cannulated and connected to a cardiotomy reservoir. All animals underwent 40-minute single cross-clamping of the proximal descending aorta while keeping proximal systolic arterial pressure above 100 mmHg. In group B, normothermic arterial blood was delivered retrogradely through the azygos vein, maintaining perfusion pressure within 25-30 mmHg. Animals were allowed to recover to perform a primary neurologic evaluation. Results: Flaccid paraplegia was uniformly observed in group A. In group B, all animals showed mild-to-moderate voluntary hind limb movements on awakening (p = 0.007). Controls also showed urine incontinence short after cross-clamping, and this was not observed in group B (p = 0.008). A different veno-arterial oxygen step-down was observed in blood collected from the excluded aorta in the two groups (p <0.001). Conclusions: Preliminary results indicate that controlled retrograde normothermic perfusion alone through the azygos system provides some degree of protection from spinal cord ischemia. Bladder dysfunction may represent a simple test to detect massive cord damage intraoperatively. Retrograde spinal cord perfusion warrants further investigation.

Original languageEnglish
Pages (from-to)124-128
Number of pages5
JournalJournal of Cardiac Surgery
Volume22
Issue number2
DOIs
Publication statusPublished - Mar 2007

Fingerprint

Spinal Cord
Perfusion
Thoracic Aorta
Constriction
Azygos Vein
Spinal Cord Ischemia
Paraplegia
Thoracotomy
Nervous System
Aorta
Arterial Pressure
Urinary Bladder
Swine
Thorax
Extremities
Urine
Oxygen
Blood Pressure
Pressure
Control Groups

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Spinal cord retrograde perfusion : Review of the literature and experimental observations. / Pocar, Marco; Rossi, Vincenzo; Addis, Alessandro; Monaco, Ario; Sichel, Sergio; Addis, Flaminio; Grossi, Adalberto; Donatelli, Francesco.

In: Journal of Cardiac Surgery, Vol. 22, No. 2, 03.2007, p. 124-128.

Research output: Contribution to journalArticle

Pocar, Marco ; Rossi, Vincenzo ; Addis, Alessandro ; Monaco, Ario ; Sichel, Sergio ; Addis, Flaminio ; Grossi, Adalberto ; Donatelli, Francesco. / Spinal cord retrograde perfusion : Review of the literature and experimental observations. In: Journal of Cardiac Surgery. 2007 ; Vol. 22, No. 2. pp. 124-128.
@article{e12154915a8640578bca2439a91bcc3e,
title = "Spinal cord retrograde perfusion: Review of the literature and experimental observations",
abstract = "Background: Spinal cord damage represents a devastating complication of thoracic and thoracoabdominal aortic surgery. Retrograde perfusion as an alternative route to protect the spinal cord has recently been investigated with controversial results. We reviewed the literature and analyzed additional experimental observations. Methods: Ten juvenile pigs were divided into control and study groups (A and B, respectively). Through a lateral thoracotomy the distal aortic arch was cannulated and connected to a cardiotomy reservoir. All animals underwent 40-minute single cross-clamping of the proximal descending aorta while keeping proximal systolic arterial pressure above 100 mmHg. In group B, normothermic arterial blood was delivered retrogradely through the azygos vein, maintaining perfusion pressure within 25-30 mmHg. Animals were allowed to recover to perform a primary neurologic evaluation. Results: Flaccid paraplegia was uniformly observed in group A. In group B, all animals showed mild-to-moderate voluntary hind limb movements on awakening (p = 0.007). Controls also showed urine incontinence short after cross-clamping, and this was not observed in group B (p = 0.008). A different veno-arterial oxygen step-down was observed in blood collected from the excluded aorta in the two groups (p <0.001). Conclusions: Preliminary results indicate that controlled retrograde normothermic perfusion alone through the azygos system provides some degree of protection from spinal cord ischemia. Bladder dysfunction may represent a simple test to detect massive cord damage intraoperatively. Retrograde spinal cord perfusion warrants further investigation.",
author = "Marco Pocar and Vincenzo Rossi and Alessandro Addis and Ario Monaco and Sergio Sichel and Flaminio Addis and Adalberto Grossi and Francesco Donatelli",
year = "2007",
month = "3",
doi = "10.1111/j.1540-8191.2006.00368.x",
language = "English",
volume = "22",
pages = "124--128",
journal = "Journal of Cardiac Surgery",
issn = "0886-0440",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Spinal cord retrograde perfusion

T2 - Review of the literature and experimental observations

AU - Pocar, Marco

AU - Rossi, Vincenzo

AU - Addis, Alessandro

AU - Monaco, Ario

AU - Sichel, Sergio

AU - Addis, Flaminio

AU - Grossi, Adalberto

AU - Donatelli, Francesco

PY - 2007/3

Y1 - 2007/3

N2 - Background: Spinal cord damage represents a devastating complication of thoracic and thoracoabdominal aortic surgery. Retrograde perfusion as an alternative route to protect the spinal cord has recently been investigated with controversial results. We reviewed the literature and analyzed additional experimental observations. Methods: Ten juvenile pigs were divided into control and study groups (A and B, respectively). Through a lateral thoracotomy the distal aortic arch was cannulated and connected to a cardiotomy reservoir. All animals underwent 40-minute single cross-clamping of the proximal descending aorta while keeping proximal systolic arterial pressure above 100 mmHg. In group B, normothermic arterial blood was delivered retrogradely through the azygos vein, maintaining perfusion pressure within 25-30 mmHg. Animals were allowed to recover to perform a primary neurologic evaluation. Results: Flaccid paraplegia was uniformly observed in group A. In group B, all animals showed mild-to-moderate voluntary hind limb movements on awakening (p = 0.007). Controls also showed urine incontinence short after cross-clamping, and this was not observed in group B (p = 0.008). A different veno-arterial oxygen step-down was observed in blood collected from the excluded aorta in the two groups (p <0.001). Conclusions: Preliminary results indicate that controlled retrograde normothermic perfusion alone through the azygos system provides some degree of protection from spinal cord ischemia. Bladder dysfunction may represent a simple test to detect massive cord damage intraoperatively. Retrograde spinal cord perfusion warrants further investigation.

AB - Background: Spinal cord damage represents a devastating complication of thoracic and thoracoabdominal aortic surgery. Retrograde perfusion as an alternative route to protect the spinal cord has recently been investigated with controversial results. We reviewed the literature and analyzed additional experimental observations. Methods: Ten juvenile pigs were divided into control and study groups (A and B, respectively). Through a lateral thoracotomy the distal aortic arch was cannulated and connected to a cardiotomy reservoir. All animals underwent 40-minute single cross-clamping of the proximal descending aorta while keeping proximal systolic arterial pressure above 100 mmHg. In group B, normothermic arterial blood was delivered retrogradely through the azygos vein, maintaining perfusion pressure within 25-30 mmHg. Animals were allowed to recover to perform a primary neurologic evaluation. Results: Flaccid paraplegia was uniformly observed in group A. In group B, all animals showed mild-to-moderate voluntary hind limb movements on awakening (p = 0.007). Controls also showed urine incontinence short after cross-clamping, and this was not observed in group B (p = 0.008). A different veno-arterial oxygen step-down was observed in blood collected from the excluded aorta in the two groups (p <0.001). Conclusions: Preliminary results indicate that controlled retrograde normothermic perfusion alone through the azygos system provides some degree of protection from spinal cord ischemia. Bladder dysfunction may represent a simple test to detect massive cord damage intraoperatively. Retrograde spinal cord perfusion warrants further investigation.

UR - http://www.scopus.com/inward/record.url?scp=33847419878&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33847419878&partnerID=8YFLogxK

U2 - 10.1111/j.1540-8191.2006.00368.x

DO - 10.1111/j.1540-8191.2006.00368.x

M3 - Article

C2 - 17338745

AN - SCOPUS:33847419878

VL - 22

SP - 124

EP - 128

JO - Journal of Cardiac Surgery

JF - Journal of Cardiac Surgery

SN - 0886-0440

IS - 2

ER -