AW: AW: AW: [HSF] It´s the cord,
Dr. Roberto Battellini
battr at medizin.uni-leipzig.de
Wed Nov 1 13:51:54 EST 2006
My idea is that perfusion of the descending aorta antegradely through a
balloon catheter after the left subclavia or retrogradelly through the
femoral with the distal arch anastomosis done can perfuse the cord.
But, well, we are talking about the cord temperature and time in which one
could get a paraplegia operating the arch.
I have no data out of more than 15 minutes at 37 you could get a
paraplegia.
Roberto
-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von prasannasimha
Gesendet: Mittwoch, 1. November 2006 10:16
An: OpenHeart-L at lists.hsforum.com
Betreff: Re: AW: AW: [HSF] It´s the cord, ...Clinton says
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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>> >> entregas en todo el mundo, YupiMSN Compras: Haz
>> >> clic aquí... <http://g.msn.com/8HMBES/2746??PS=47575>
>> >>
>> >>
>> >>
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>> > Giulio Rizzoli MD FETCS
>> > Cardiochirurgia Padova
>> > tel. 049 821-2408
>> > fax 049 821-2409
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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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