Background: Hypothermic cardiopulmonary bypass with or without an interval of circulatory arrest has been evaluated for the treatment of complex aortic disease of the descending thoracic and thoracoabdominal aorta. Hypothermia has a protective effect on spinal cord function, and its use should reduce the incidence of paraplegia and paraparesis in traditionally high-risk patients. Experimentally, the protective effect of hypothermia has been related to amelioration of excitotoxic injury by reduction of neurotransmitter release and to inhibition of delayed apoptopic cell death.Methods: During a 12-year period, 114 patients with descending thoracic or thoracoabdominal aortic disease underwent replacement of the involved aortic segments using hypothermic cardiopulmonary bypass and intervals of circulatory arrest. The mean age of the patients was 60 years (range 22 to 79 years). Acute or chronic dissection was present in 40 patients (35%). Sixty-four patients (56%) had Crawford Types I, II, or III thoracoabdominal aneurysms.Results: The hospital mortality was 8% (9 patients). Paraplegia occured in 2 and paraparesis in 1 of the 108 patients whose lower limb function was assessed postoperatively (2.8%). None of 40 patients with aortic dissection and none of the last 81 patients in the series developed paralysis. One patient developed renal failure that required dialysis.Conclusions: Our experience with hypothermic cardiopulmonary bypass and circulatory arrest confirms that hypothermia provides substantial protection against spinal cord ischemic injury. It allows complex operations on the descending thoracic and thoracoabdominal aorta to be performed with acceptable mortality, a low incidence of renal failure, and an incidence of other complications that does not exceed that reported with other techniques.
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Crawford ES, Coselli JS, Safi HJ. Partial cardiopulmonary bypass, hypothermic circulatory arrest, and Posterolateral exposure for thoracic aortic aneurysm operation. J Thorac Cardiovasc Surg 1987; 94: 824–7.
Kouchoukos NT, Wareing TH, Izumoto H, et al. Elective hypothermic cardiopulmonary bypass and circulatory arrest for spinal cord protection during operations of the thoracoabdominal aorta. J Thorac Cardiovasc Surg 1990; 99: 659–64.
Kieffer E, Koskas F, Walden R, et al. Hypothermic circulatory arrest for thoracic aneurysmectomy through left-sided thoracotomy. J Yasc Surg 1994; 19: 457–64.
Kouchoukos NT, Daily BB, Rokkas CK, et al. Hypothermic bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta. Ann Thorac Surg 1995; 60: 67–77.
Coles JG, Wilson GJ, Sima AF, et al. Intraoperative management of thoracic aortic anuerysms. Experimental evaluation of perfusion cooling of the spinal cord. J Thorac Cardiovasc 1983; 85: 292–9.
Colon R, Frazier OH, Cooley DA, McAllister HA. Hypothermic regional perfusion for protection of the spinal cord during periods of ischemia. Ann Thorac Surg 1987; 43: 639–43.
Berguer R, Porto J, Fedoronko B, Dragovic L. Selective deep hypothermia of the spinal cord prevents paraplegia after aortic cross-clamping in the dog model. J Vasc Surg 1992; 15: 62–72.
Salzano RP, Ellison LH, Altonji PF, et al. Regional deep hypothermia of the spinal cord protects against ischemic injury during thoracic aortic cross-clamping. Ann Thorac Surg 1994; 57: 65–71.
Wisselink W, Becker MO, Nguyen JH, et al. Protecting the ischemic spinal cord during aortic clamping: The influence of selective hypothermia and spinal cord perfusion pressure. J Vasc Surg 1994; 19: 788–96.
Rokkas CK, Sundaresan S, Shuman TA, et al. Profound systemic hypothermia protects the spinal cord in a primate model of spinal cord ischemia. J Thorac Cardiovasc Surg 1993; 106: 1024–35.
Frank SM, Parker SD, Rock P, et al. Moderate hypothermia, with partial bypass and segmental sequential repair for thoracoabdominal aortic aneurysm. J Vasc Surg 1994; 19: 687–97.
Cambria RP, Davision JK, Zannetti S, et al. Clinical experience with epidural cooling for spinal cord protection during thoracic and thoracoabdominal aneurysm repair. 1997; 25: 234–43.
Hagerdal M, Harp J, Nilsson L, Siesjo BK. The effect of induced hypothermia upon oxygen consumption in the rat brain. J Neurochem 1975; 24: 311–6.
Fox SI, Blackstone E, Kirklin JW, et al. Relationship of brain blood flow and oxygen consumption to perfusion flow rate during profoundly hypothermic cardiopulmonary bypass. An experimental study. J Thorac Cardiovasc Surg 1984; 87: 658–64.
Michenfelder JD, Milde JH. The relationship among canine brain temperature, metabolism, and function during hypothermia. Anesthesiol 1991; 75: 130–6.
Todd MM, Warner DS. A comfortable hypothesis reevaluated. Cerebral metabolic depression and brain protection during ischemia. Anesthesiol 1992; 76: 161–4
Nakashima K, Todd MM, Warner DS. The relationship between cerebral metabolic rate and ischemic depolarization. A comparison of the effects of hypothermia, pentobarbital and isoflurane. Anesthesiol 1995; 82: 1199–208.
Choi DW, Rothman SM. The role of glutamate neurotoxicity in hypoxic-ischemic neuronal death. Annu Rev Neurosci 1990; 13: 171–82.
Choi DW. Methods of antagonizing glutamate neurotoxicity. Cerebrovasc Brain Metab Rev 1990; 2: 105–47.
Benveniste H. The excitotoxin hypothesis in relation to cerebral ischemia. Cerebrovasc Brain Metab Rev 1991; 3: 213–45.
Faden AI, Simon RP. A potential role for excitotoxins in the pathophysiology of spinal cord injury. Ann Neurol 1988; 23: 623–6.
Simpson RK, Robertson CS, Goodman JC. Spinal cord ischemia-induced evaluation of amino-acids: Extracellular measurement with microdialysis. Neurochem Res 1990; 15: 635–9.
Regan RF, Choi DW. Glutamate neurotixicity in spinal cord cell culture. Neuroscience 1991; 43: 585–91.
Rokkas CK, Helfrich IR, Lobner DC, et al. Dextrorphan inhibits the release of excitatory amino acids during spinal cord ischemia. Am Thorac Surg 1994; 58: 312–20.
Busto R, Globus MY-T, Dietrich WD, et al. Effect of mild hypothermia on ischemia-induced release of neurotransmitters and free fatty acids in rat brain. Stroke 1989; 20: 904–10.
Ginsberg MD, Globus MY-T, Dietrich WD, Busto R. Temperature modulation of ischemic brain injury-a synthesis of recent advances. Prog Brain Res 1993; 96: 13–22.
Rokkas CK, Cronin CS, Nitta T, et al. Profound systemic hypothermia inhibits the release of neurotransmitter amino acids in spinal cord ischemia. J Thorac Cardiovasc Surg 1995; 110: 27–35.
Mackey ME, Wu Y, Hu R, et al. Cell death suggestive of apoptosis after spinal cord ischemia in rabbits. 1997; 114: 609–18.
Kato H, Kannelopoulos GK, Matsuo S, et al. Protection of rat spinal cord ischemia with dextrorphan and cycloheximide: Effects on necrosis and apoptosis. J Thorac Cardiovasc Surg 1997; 114: 609–18.
Masahiro S, Takeshi H, et al. Delayed and selective motor neuron death after transient spinal cord ischemia: a role of apoptosis?
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Kouchoukos, N.T. Hypothermic circulatory arrest and hypothermic perfusion for extensive disease of the thoracic and thoracoabdominal aorta. Jpn J Thorac Caridovasc Surg 47, 1–5 (1999). https://doi.org/10.1007/BF03217932
- circulatory arrest
- thoracoabdominal aorta
- hypothermic cardiopulmonary bypass