Retrograde venous perfusion with hypothermic saline and adenosine for protection of the ischemic spinal cord

Patrick E. Parrino, Irving L. Kron, Scott D. Ross, Kimberly S. Shockey, Michael J. Fisher, John R. Gaughen, David F Kallmes, John A. Kern, Curtis G. Tribble

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Purpose: Spinal cord injury and the resultant postoperative paraplegia are devastating complications of thoracic aortic surgery, for which no widely accepted protective interventions exist. We hypothesized that retrograde venous perfusion-cooling of the spinal cord with a hypothermic saline and adenosine solution would protect it from ischemic injury caused by thoracic aortic occlusion. Methods: Adult domestic swine of either sex (weight range, 20 to 30 kg) were intubated and ventilated. A left thoracotomy was performed. The accessory hemiazygous vein was divided, and a catheter was inserted distally. The aorta was clamped at the left subclavian artery. The venous catheter was not used in the animals in the control group (n = 7); in the animals in the experimental group (n = 7), a cold (4°C) saline and adenosine solution was infused into the accessory hemiazygous vein. After 30 minutes, the clamp and catheter were removed, and the chest was closed. A blinded observer evaluated the animals' hind-leg motor activity 24 hours later. The Tarlov scale was used: 0, complete paralysis; 1, minimal movement; 2, stands with assistance; 3, stands alone; 4, weak walk; 5, normal gait. The animals' rectal temperatures were measured at the end of the experiment, and blood pressure was measured throughout. Two other groups were studied to assess the effect of the intervention on spinal cord temperature. Results: The animals in the control group had a mean Tarlov score of 1.7 ± 0.6; the animals in the experimental group had a mean Tarlov score of 4.9 ± 0.1 (P < .01). The animals in the experimental group had a significantly greater drop in spinal cord temperature than those in the control group (4.05 ± 0.6°C vs 0.58 ± 0.12°C; P < .01). No significant difference in rectal temperatures was found, nor did any arrhythmias or hypotensive episodes occur in either group. Perfusion of the spinal cord was confirmed with angiography by using this approach. Conclusion: Retrograde venous perfusion-cooling of the spinal cord with a hypothermic saline and adenosine solution protects the cord from ischemic injury caused by clamping of the thoracic aorta.

Original languageEnglish (US)
Pages (from-to)171-178
Number of pages8
JournalJournal of Vascular Surgery
Volume32
Issue number1
DOIs
StatePublished - Jul 2000
Externally publishedYes

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Adenosine
Spinal Cord
Perfusion
Sodium Chloride
Temperature
Catheters
Control Groups
Veins
Thoracic Injuries
Subclavian Artery
Paraplegia
Thoracotomy
Thoracic Aorta
Spinal Cord Injuries
Gait
Constriction
Paralysis
Thoracic Surgery
Aorta
Cardiac Arrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Parrino, P. E., Kron, I. L., Ross, S. D., Shockey, K. S., Fisher, M. J., Gaughen, J. R., ... Tribble, C. G. (2000). Retrograde venous perfusion with hypothermic saline and adenosine for protection of the ischemic spinal cord. Journal of Vascular Surgery, 32(1), 171-178. https://doi.org/10.1067/mva.2000.105003

Retrograde venous perfusion with hypothermic saline and adenosine for protection of the ischemic spinal cord. / Parrino, Patrick E.; Kron, Irving L.; Ross, Scott D.; Shockey, Kimberly S.; Fisher, Michael J.; Gaughen, John R.; Kallmes, David F; Kern, John A.; Tribble, Curtis G.

In: Journal of Vascular Surgery, Vol. 32, No. 1, 07.2000, p. 171-178.

Research output: Contribution to journalArticle

Parrino, PE, Kron, IL, Ross, SD, Shockey, KS, Fisher, MJ, Gaughen, JR, Kallmes, DF, Kern, JA & Tribble, CG 2000, 'Retrograde venous perfusion with hypothermic saline and adenosine for protection of the ischemic spinal cord', Journal of Vascular Surgery, vol. 32, no. 1, pp. 171-178. https://doi.org/10.1067/mva.2000.105003
Parrino, Patrick E. ; Kron, Irving L. ; Ross, Scott D. ; Shockey, Kimberly S. ; Fisher, Michael J. ; Gaughen, John R. ; Kallmes, David F ; Kern, John A. ; Tribble, Curtis G. / Retrograde venous perfusion with hypothermic saline and adenosine for protection of the ischemic spinal cord. In: Journal of Vascular Surgery. 2000 ; Vol. 32, No. 1. pp. 171-178.
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abstract = "Purpose: Spinal cord injury and the resultant postoperative paraplegia are devastating complications of thoracic aortic surgery, for which no widely accepted protective interventions exist. We hypothesized that retrograde venous perfusion-cooling of the spinal cord with a hypothermic saline and adenosine solution would protect it from ischemic injury caused by thoracic aortic occlusion. Methods: Adult domestic swine of either sex (weight range, 20 to 30 kg) were intubated and ventilated. A left thoracotomy was performed. The accessory hemiazygous vein was divided, and a catheter was inserted distally. The aorta was clamped at the left subclavian artery. The venous catheter was not used in the animals in the control group (n = 7); in the animals in the experimental group (n = 7), a cold (4°C) saline and adenosine solution was infused into the accessory hemiazygous vein. After 30 minutes, the clamp and catheter were removed, and the chest was closed. A blinded observer evaluated the animals' hind-leg motor activity 24 hours later. The Tarlov scale was used: 0, complete paralysis; 1, minimal movement; 2, stands with assistance; 3, stands alone; 4, weak walk; 5, normal gait. The animals' rectal temperatures were measured at the end of the experiment, and blood pressure was measured throughout. Two other groups were studied to assess the effect of the intervention on spinal cord temperature. Results: The animals in the control group had a mean Tarlov score of 1.7 ± 0.6; the animals in the experimental group had a mean Tarlov score of 4.9 ± 0.1 (P < .01). The animals in the experimental group had a significantly greater drop in spinal cord temperature than those in the control group (4.05 ± 0.6°C vs 0.58 ± 0.12°C; P < .01). No significant difference in rectal temperatures was found, nor did any arrhythmias or hypotensive episodes occur in either group. Perfusion of the spinal cord was confirmed with angiography by using this approach. Conclusion: Retrograde venous perfusion-cooling of the spinal cord with a hypothermic saline and adenosine solution protects the cord from ischemic injury caused by clamping of the thoracic aorta.",
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AU - Parrino, Patrick E.

AU - Kron, Irving L.

AU - Ross, Scott D.

AU - Shockey, Kimberly S.

AU - Fisher, Michael J.

AU - Gaughen, John R.

AU - Kallmes, David F

AU - Kern, John A.

AU - Tribble, Curtis G.

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N2 - Purpose: Spinal cord injury and the resultant postoperative paraplegia are devastating complications of thoracic aortic surgery, for which no widely accepted protective interventions exist. We hypothesized that retrograde venous perfusion-cooling of the spinal cord with a hypothermic saline and adenosine solution would protect it from ischemic injury caused by thoracic aortic occlusion. Methods: Adult domestic swine of either sex (weight range, 20 to 30 kg) were intubated and ventilated. A left thoracotomy was performed. The accessory hemiazygous vein was divided, and a catheter was inserted distally. The aorta was clamped at the left subclavian artery. The venous catheter was not used in the animals in the control group (n = 7); in the animals in the experimental group (n = 7), a cold (4°C) saline and adenosine solution was infused into the accessory hemiazygous vein. After 30 minutes, the clamp and catheter were removed, and the chest was closed. A blinded observer evaluated the animals' hind-leg motor activity 24 hours later. The Tarlov scale was used: 0, complete paralysis; 1, minimal movement; 2, stands with assistance; 3, stands alone; 4, weak walk; 5, normal gait. The animals' rectal temperatures were measured at the end of the experiment, and blood pressure was measured throughout. Two other groups were studied to assess the effect of the intervention on spinal cord temperature. Results: The animals in the control group had a mean Tarlov score of 1.7 ± 0.6; the animals in the experimental group had a mean Tarlov score of 4.9 ± 0.1 (P < .01). The animals in the experimental group had a significantly greater drop in spinal cord temperature than those in the control group (4.05 ± 0.6°C vs 0.58 ± 0.12°C; P < .01). No significant difference in rectal temperatures was found, nor did any arrhythmias or hypotensive episodes occur in either group. Perfusion of the spinal cord was confirmed with angiography by using this approach. Conclusion: Retrograde venous perfusion-cooling of the spinal cord with a hypothermic saline and adenosine solution protects the cord from ischemic injury caused by clamping of the thoracic aorta.

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