THE EVALUATION OF MEDULLA SPINALIS PERFUSION AT MODERATE HYPOTHERMIA
WITH PATIENTS WHO UNDERGO ANTEGRADE SELECTIVE CEREBRAL PERFUSION IN
ASCENDING AND ARCUS AORTIC SURGERY
Abstract
Aim: Antegrade Selective Cerebral Perfusion (ASCP) with lower
body circulatory arrest (LBCA) used in aortic arch surgery can lead to
postoperative ischemic organ dysfunctions if it lasts long enough. We
aimed to evaluate methods that can provide early detection of spinal
cord ischemia during aortic arch surgery. Methods: Thirty
consecutive patients were prospectively enrolled and Near infrared
spectrometry (NIRS) data obtained from the 5 th and 10
th thoracic vertebral region, S100β protein, lactate
blood levels during various operative phases and postoperative
neurological outcomes were evaluated. Results: A total of 30
patients underwent elective hemi arch (73.29%) or total arch (23.31%)
replacement and with a mean ASCP period of 25.1 ± 19.0 (limits 10-90)
minutes. In-hospital mortality was 6.66% (two patients). Paraparesis
developed in one patient (3,33%). Thoracic T5 and T10 NIRS values were
lowest during the ASCP period (p<0.001) with a good
correlation between them (r=0.853, p<0.001). However, a
significant difference between the T5 and T10 levels was observed during
the same period (55.40 vs 51.07 respectively, p=0.001). A moderately
negative correlation between the lactate levels in descending aorta and
NIRS values at the T10 level was found during ASCP (r =-0.514, p =
0.004). Conclusion: Thoracic 5 th and 10
th level NIRS monitoring for spinal cord oxygenation
were significantly lower during ASCP period compared to the other
periods of aortic arch surgery with T10 values being lower than T5
values during the same period indicating a more significant flow
disturbance at this level. Measuring lactate levels with thoracic NIRS
monitoring seems promising for future studies with larger volumes and
longer ASCP periods.