{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T10:00:57Z","timestamp":1764842457012,"version":"3.37.3"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,4,11]],"date-time":"2021-04-11T00:00:00Z","timestamp":1618099200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"European Union\u2019s Horizon 2020","award":["733203"],"award-info":[{"award-number":["733203"]}]},{"DOI":"10.13039\/501100001659","name":"German Research Foundation","doi-asserted-by":"crossref","award":["127\/2-1"],"award-info":[{"award-number":["127\/2-1"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>\u2002<\/jats:title><\/jats:sec><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>Distal aortic perfusion (DaP) is a widely accepted protective adjunct facilitating early reinstitution of visceral perfusion during extended thoracic and thoraco-abdominal aortic repair. DaP has also been suggested to secure distal inflow to the paraspinal collateral network via the hypogastric arteries and thereby reduce the risk of spinal cord ischaemia. However, an increase in cerebrospinal fluid (CSF) pressure is frequently observed during thoracoabdominal aortic aneurysm repair. The aim of this study was to evaluate the effects of DaP on regional spinal cord blood flow (SCBF) during descending aortic cross-clamping and iatrogenic elevation of cerebrospinal fluid pressure.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Eight juvenile pigs underwent central cannulation for cardiopulmonary bypass according to our established experimental protocol followed by aortic cross-clamping of the descending thoracic and abdominal aorta\u2014mimicking sequential aortic clamping\u2014with the initiation of DaP. Thereafter, CSF pressure elevation was induced by the infusion of blood plasma until baseline CSF pressure was tripled. At each time-point, microspheres of different colours were injected allowing for regional SCBF analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>DaP led to a pronounced hyperperfusion of the distal spinal cord [SCBF up to 480%, standard deviation (SD): 313%, compared to baseline]. However, DaP provided no or only limited additional flow to the upper and middle segments of the spinal cord (C1\u2013Th7: 5% of baseline, SD: 5%; Th8\u2013L2: 24%, SD: 39%), which was compensated by proximal flow only at C1\u2013Th7 level. Furthermore, DaP could not counteract an experimental CSF pressure elevation, which led to a further decrease in regional SCBF most pronounced in the mid-thoracic spinal cord segment.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Protective DaP during thoraco-abdominal aortic repair may be associated with inadequate spinal protection particularly at the mid-thoracic spinal cord level (\u2018watershed area\u2019) and result in the adverse effect of a potentially dangerous hyperperfusion of the distal spinal cord segments.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezab167","type":"journal-article","created":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T20:11:35Z","timestamp":1615925495000},"page":"569-576","source":"Crossref","is-referenced-by-count":5,"title":["Effect of cerebrospinal fluid pressure elevation on spinal cord perfusion during aortic cross-clamping with distal aortic perfusion"],"prefix":"10.1093","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1742-5841","authenticated-orcid":false,"given":"Josephina","family":"Haunschild","sequence":"first","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"},{"name":"Heisenberg Working Group for Aortic Surgery, Saxonian Incubator for Clinical Translation (SIKT), University Leipzig, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5579-9345","authenticated-orcid":false,"given":"Zara","family":"Khachatryan","sequence":"additional","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"},{"name":"Heisenberg Working Group for Aortic Surgery, Saxonian Incubator for Clinical Translation (SIKT), University Leipzig, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantin","family":"von Aspern","sequence":"additional","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"},{"name":"Heisenberg Working Group for Aortic Surgery, Saxonian Incubator for Clinical Translation (SIKT), University Leipzig, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna","family":"Heraj\u00e4rvi","sequence":"additional","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"},{"name":"Heisenberg Working Group for Aortic Surgery, Saxonian Incubator for Clinical Translation (SIKT), University Leipzig, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5218-3126","authenticated-orcid":false,"given":"Susann","family":"Ossmann","sequence":"additional","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg","family":"Naumann","sequence":"additional","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"},{"name":"Heisenberg Working Group for Aortic Surgery, Saxonian Incubator for Clinical Translation (SIKT), University Leipzig, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A","family":"Borger","sequence":"additional","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8224-2390","authenticated-orcid":false,"given":"Christian D","family":"Etz","sequence":"additional","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"},{"name":"Heisenberg Working Group for Aortic Surgery, Saxonian Incubator for Clinical Translation (SIKT), University Leipzig, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,4,11]]},"reference":[{"key":"2021091118384214000_ezab167-B1","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1161\/CIRCULATIONAHA.108.769695","article-title":"Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques","volume":"118","author":"Greenberg","year":"2008","journal-title":"Circulation"},{"key":"2021091118384214000_ezab167-B2","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1038\/sc.2016.182","article-title":"Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury","volume":"55","author":"Hatch","year":"2017","journal-title":"Spinal Cord"},{"key":"2021091118384214000_ezab167-B3","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1093\/ejcts\/ezv142","article-title":"Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery","volume":"47","author":"Etz","year":"2015","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021091118384214000_ezab167-B4","doi-asserted-by":"crossref","first-page":"e266","DOI":"10.1161\/CIR.0b013e3181d47d48","article-title":"2010 ACCF\/AHA\/AATS\/ACR\/ASA\/SCA\/SCAI\/SIR\/STS\/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine","volume":"121","author":"Hiratzka","year":"2010","journal-title":"Circulation"},{"key":"2021091118384214000_ezab167-B5","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1067\/mva.2002.122024","article-title":"Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial","volume":"35","author":"Coselli","year":"2002","journal-title":"J Vasc Surg"},{"key":"2021091118384214000_ezab167-B6","first-page":"CD008197","article-title":"Distal aortic perfusion during thoracoabdominal aneurysm repair for prevention of paraplegia","author":"Hsu","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"2021091118384214000_ezab167-B7","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1001\/archsurg.1997.01430300075016","article-title":"Protective effect of hypothermia and left heart bypass on spinal ischemia in the dog","volume":"132","author":"Rose","year":"1997","journal-title":"Arch Surg"},{"key":"2021091118384214000_ezab167-B8","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1080\/140174302317282320","article-title":"Spinal cord protection during aortic cross clamping: retrograde venous spinal cord perfusion, distal aortic perfusion, and cerebrospinal fluid drainage","volume":"36","author":"Winnerkvist","year":"2002","journal-title":"Scand Cardiovasc J"},{"edition":"8th edn","volume-title":"Guide for the Care and Use of Laboratory Animals","year":"2011","key":"2021091118384214000_ezab167-B9"},{"key":"2021091118384214000_ezab167-B10","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1093\/ejcts\/ezaa038","article-title":"Detrimental effects of cerebrospinal fluid pressure elevation on spinal cord perfusion: first-time direct detection in a large animal model","volume":"58","author":"Haunschild","year":"2020","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021091118384214000_ezab167-B11","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1016\/j.ejcts.2008.01.069","article-title":"Spinal cord blood flow and ischemic injury after experimental sacrifice of thoracic and abdominal segmental arteries","volume":"33","author":"Etz","year":"2008","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021091118384214000_ezab167-B12","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S0003-4975(10)60481-X","article-title":"Experimental and clinical assessment of the adequacy of partial bypass in maintenance of spinal cord blood flow during operations on the thoracic aorta","volume":"36","author":"Laschinger","year":"1983","journal-title":"Ann Thorac Surg"},{"key":"2021091118384214000_ezab167-B13","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/0741-5214(93)90421-H","article-title":"Experience with 1509 patients undergoing thoracoabdominal aortic operations","volume":"17","author":"Svensson","year":"1993","journal-title":"J Vasc Surg"},{"key":"2021091118384214000_ezab167-B14","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1097\/01.sla.0000086664.90571.7a","article-title":"Distal aortic perfusion and cerebrospinal fluid drainage for thoracoabdominal and descending thoracic aortic repair: ten years of organ protection","volume":"238","author":"Safi","year":"2003","journal-title":"Ann Surg"},{"key":"2021091118384214000_ezab167-B15","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/j.jtcvs.2015.12.050","article-title":"Outcomes of 3309 thoracoabdominal aortic aneurysm repairs","volume":"151","author":"Coselli","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021091118384214000_ezab167-B16","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/j.ejcts.2004.01.033","article-title":"Introduction of adjuncts and their influence on changing results in 402 consecutive thoracoabdominal aortic aneurysm repairs","volume":"25","author":"Schepens","year":"2004","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021091118384214000_ezab167-B17","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/0003-4975(95)00447-S","article-title":"Retrograde cerebral and distal aortic perfusion during ascending and thoracoabdominal aortic operations","volume":"60","author":"Bavaria","year":"1995","journal-title":"Ann Thorac Surg"},{"key":"2021091118384214000_ezab167-B18","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1016\/j.jvs.2010.11.055","article-title":"Evolution of operative strategies in open thoracoabdominal aneurysm repair","volume":"53","author":"Conrad","year":"2011","journal-title":"J Vasc Surg"},{"key":"2021091118384214000_ezab167-B19","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1007\/s10016-004-0072-z","article-title":"Ten years experience of thoracic and thoracoabdominal aortic aneurysm surgical repair: lessons learned","volume":"18","author":"Chiesa","year":"2004","journal-title":"Ann Vasc Surg"},{"key":"2021091118384214000_ezab167-B20","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1089\/neu.2018.5961","article-title":"Spinal cord blood flow in patients with acute spinal cord injuries","volume":"36","author":"Gallagher","year":"2019","journal-title":"J Neurotrauma"},{"key":"2021091118384214000_ezab167-B21","doi-asserted-by":"crossref","first-page":"2130","DOI":"10.1016\/j.athoracsur.2007.01.060","article-title":"Anatomy of spinal cord blood supply in the pig","volume":"83","author":"Strauch","year":"2007","journal-title":"Ann Thorac Surg"},{"key":"2021091118384214000_ezab167-B22","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1093\/ejcts\/ezy058","article-title":"New insights into spinal cord ischaemia after thoracic aortic procedures: the importance of the number of anterior radiculomedullary arteries for surgical outcome","volume":"54","author":"Kari","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021091118384214000_ezab167-B23","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1080\/00365510701196906","article-title":"Regional distribution of blood flow during proximal aortic cross-clamping: an experimental study using coloured microspheres","volume":"67","author":"Brattli","year":"2007","journal-title":"Scand J Clin Lab Invest"},{"key":"2021091118384214000_ezab167-B24","first-page":"S0022","article-title":"Mapping the collateral network: optimal near-infrared spectroscopy optode placement","volume-title":"J Thorac Cardiovasc Surg","author":"von Aspern","year":"2020"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/60\/3\/569\/40350504\/ezab167.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/60\/3\/569\/40350504\/ezab167.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T03:03:41Z","timestamp":1724641421000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/60\/3\/569\/6220260"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,11]]},"references-count":24,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,4,11]]},"published-print":{"date-parts":[[2021,9,11]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezab167","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"type":"print","value":"1010-7940"},{"type":"electronic","value":"1873-734X"}],"subject":[],"published-other":{"date-parts":[[2021,9,1]]},"published":{"date-parts":[[2021,4,11]]}}}