Re: AW: AW: [HSF] It´s the cord, ...Clinton says

Wed Nov 1 10:04:04 EST 2006

The concern about the chord is right, because 
paraplegia is the most dreadfull complication for 
any patient, nonetheless I have always been 
teaced that 30' are pretty safe if you repair an 
isthmic transection with the Cooley "clamp and 
go" technique (in the nomogram reported by 
Kirklin's book 2°nd edition, on page 1710  the probability is about 10%).
Nonetheless this data are for normothermia!
If You runa perfusion at 28° prior to circulatory 
arrest you should have the added protection of some cooling.
Furthermore if the origin of the subclavian 
artery is snared, while perfusing both carotid 
arteries at 28° , there must be perfusion of the 
chord by the subclavian collateral circulation 
through vertebrals, mammary, intercostal arteries, aso.
The numbers you report are the extimated safe 
protection of the brain during circulatory arrest !
I was wondering if there are in the litterature 
estimates of the safe time of circulatory arrest 
in the lower body (Kidney liver and chord) while 
running selective cerebral perfusion with the Kazui technique.
In my "unfortunately too small" experience it was 
safe up to 35', plenty of time to carefully 
prepare an open aortic arch anastomosis.
                                         Giulio Rizzoli

>What I tried to say was that, Prasanna, the cord, that ist he question .
>Hamlet
>-----Ursprüngliche Nachricht-----
>Von: openheart-l-bounces at lists.hsforum.com
>[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von prasannasimha
>Gesendet: Dienstag, 31. Oktober 2006 13:47
>An: OpenHeart-L at lists.hsforum.com
>Betreff: Re: AW: [HSF] porcellan aorta
>
>My main concern with this trend to "normothermic" brain surgery is that
>we are not protecting the cord. This can lead to unacceptable paraplegia
>if lower body perfusion is interrupted. This may not be so much of a
>concern if lower body perfusion is maintained.
>TCA at 18 deg - 45 min
>TCA at 28 Deg 15 min
>TCA at 32 Deg - 7 min are probably estimates of TCA with negligible
>complications. Beyond this there will be a progressive increase in
>complications.
>
>Prasanna
>
>Dr. Roberto Battellini wrote:
> > No, no data. I confess I am still very conservative, remember the people
>of
> > Mount Sinai doing it at 18 grades! Remember the book of Edmunds in
>ctesnet.
> > So for me, 20 Degrees Oesophagus was courageous.But the patient is now at
> > normal station!.
> >
> > You opened a very nice question for the HSF, let´s do together.
> > At which oesophagus-rectal, etc temperature do the members  make total
> > circulatory arrest without any complication!!!(including paraplegia) , and
> > how long is it sure.
> >
> > Roberto
> >
> >
> > -----Ursprüngliche Nachricht-----
> > Von: openheart-l-bounces at lists.hsforum.com
> > [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Giulio
>Rizzoli
> > Gesendet: Montag, 30. Oktober 2006 09:11
> > An: OpenHeart-L at lists.hsforum.com
> > Betreff: Re: [HSF] porcellan aorta
> >
> > Beautiful picture !  Why 20° temperature ?
> > At 27° you can arrest the brain circulation
> > safely for 10 m'. Plenty of time to cannulate the
> > left carotid artery , occlude the left subclavian
> > e completely rperfuse the brain.
> > I think the question is : How long will  normal
> > kidney and liver tolerate ischemia at 27° ? Do You have data on it?
> >                                                  Giulio Rizzoli
> >
> >
> >
> >
> >>  We cannulated the axillary artery and went to 20 degrees oesophagus. .
> >> Roberto and Giuseppe, Leipzig
> >>
> >> ------------------------------------------------------------------------
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> >>
> >>
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> > Giulio Rizzoli MD FETCS
> > Cardiochirurgia Padova
> > tel. 049 821-2408
> > fax 049 821-2409
> > e-mail giulio.rizzoli at unipd.it
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Giulio Rizzoli MD FETCS
Cardiochirurgia Padova
tel. 049 821-2408
fax 049 821-2409
e-mail giulio.rizzoli at unipd.it