Download PDF
CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg
DOI: 10.1055/a-2318-5855
Short Communication

Cool-Shot Technique to Protect Spinal Cord during Thoracoabdominal Aortic Replacement

Taira Yamamoto
1   Department of Cardiovascular Surgery, Juntendo University Nerima Hospital, Nerima-ku, Japan
,
Daisuke Endo
2   Department of Cardiovascular Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
,
Yasutaka Yokoyama
2   Department of Cardiovascular Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
,
Minoru Tabata
2   Department of Cardiovascular Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
› Author Affiliations
› Further Information
   Permissions and Reprints All articles of this category

Abstract

Deep hypothermia helps protect the spinal cord, but is invasive. Here, we present a method to avoid reperfusion injury by selectively circulating cold blood under high pressure to the intercostal artery during reperfusion after intercostal artery reconstruction. Of the 23 patients who underwent thoracoabdominal aortic aneurysm open repair, one died. The motor evoked potential disappeared during aortic clamping in nine patients. Six patients recovered completely from aortic clamping release, two showed recovery >50% and one achieved full recovery 3 months later. Permanent motor impairment did not occur. This method could prevent reperfusion injury and paraplegia following thoracoabdominal aortic aneurysm surgery.

Keywords

thoracoabdominal aortic aneurysm - cool-shot technique - spinal cord protection - reperfusion injury

Data Availability Statement

The data associated with this manuscript are not publicly available; however, they can be provided by the corresponding author upon reasonable request.




Publication History

Received: 14 January 2024

Accepted: 22 April 2024

Accepted Manuscript online:
03 May 2024

Article published online:
11 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Coselli JS, LeMaire SA, Preventza O. et al. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg 2016; 151 (05) 1323-1337
    CrossrefPubMedGoogle Scholar
  • 2 Gaudino M, Khan FM, Rahouma M. et al. Spinal cord injury after open and endovascular repair of descending thoracic and thoracoabdominal aortic aneurysms: a meta-analysis. J Thorac Cardiovasc Surg 2022; 163 (02) 552-564
    CrossrefPubMedGoogle Scholar
  • 3 Murana G, Castrovinci S, Kloppenburg G. et al. Open thoracoabdominal aortic aneurysm repair in the modern era: results from a 20-year single-centre experience. Eur J Cardiothorac Surg 2016; 49 (05) 1374-1381
    CrossrefPubMedGoogle Scholar
  • 4 Norton EL, Orelaru F, Ahmad RA. et al. Hypothermic circulatory arrest versus aortic clamping in thoracic and thoracoabdominal aortic aneurysm repair. J Card Surg 2022; 37 (12) 4351-4358
    CrossrefPubMedGoogle Scholar
  • 5 Imamura Y, Kin H, Yoshioka K, Tabayashi A, Saitoh D. Thoracoabdominal aortic aneurysm repair based on pre- and postoperative evaluation of the artery of Adamkiewicz. Eur J Cardiothorac Surg 2022; 62 (05) ezac196
    CrossrefPubMedGoogle Scholar
  • 6 Tanaka Y, Kawaguchi M, Noguchi Y. et al. Systematic review of motor evoked potentials monitoring during thoracic and thoracoabdominal aortic aneurysm open repair surgery: a diagnostic meta-analysis. J Anesth 2016; 30 (06) 1037-1050
    CrossrefPubMedGoogle Scholar
  • 7 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 (05) 874-883
    CrossrefPubMedGoogle Scholar
  • 8 Weiss AJ, Lin HM, Bischoff MS. et al. A propensity score-matched comparison of deep versus mild hypothermia during thoracoabdominal aortic surgery. J Thorac Cardiovasc Surg 2012; 143 (01) 186-193
    CrossrefPubMedGoogle Scholar
  • 9 Kulik A, Castner CF, Kouchoukos NT. Outcomes after thoracoabdominal aortic aneurysm repair with hypothermic circulatory arrest. J Thorac Cardiovasc Surg 2011; 141 (04) 953-960
    CrossrefPubMedGoogle Scholar
  • 10 Tabayashi K, Motoyoshi N, Saiki Y. et al. Efficacy of perfusion cooling of the epidural space and cerebrospinal fluid drainage during repair of extent I and II thoracoabdominal aneurysm. J Cardiovasc Surg (Torino) 2008; 49 (06) 749-755
    PubMedGoogle Scholar