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

Wed Nov 1 14:46:28 EST 2006

Yes, what I was saying was for the brain though I do not think the cord 
is very resistant to true Ischemia (Clamping the cord involves some 
collateral flow .
Regarding Kidneys and Liver , they cannot be better than the time for 
transplantation. Unfortunately we do not flush perfuse these organs and 
isolate them so the times will be less. I have used whole body 
retroperfusion just to keep these organs cool and I do not think they 
really provide nutritive flow due to valves in the lower body venous 
circuit.
Incidentally I missed out the Clinton bit can somebody explain it to me ?
Prasanna
Giulio Rizzoli wrote:
> 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
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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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