University of Oulu

Hannu-Pekka Honkanen and others, Spinal cord injury during selective cerebral perfusion and segmental artery occlusion: an experimental study, Interactive CardioVascular and Thoracic Surgery, Volume 34, Issue 1, January 2022, Pages 145–152,

Spinal cord injury during selective cerebral perfusion and segmental artery occlusion : an experimental study

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Author: Honkanen, Hannu-Pekka1; Mustonen, Caius1; Tuominen, Hannu2;
Organizations: 1Department of Surgery, Research Unit of Surgery, Anaesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland
2Department of Pathology, Oulu University Hospital, Oulu, Finland
3Department of Surgery, Heart Center, University of Turku and Turku University Hospital, Turku, Finland
4Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: Oxford University Press, 2022
Publish Date: 2023-06-15


Objectives: Since selective cerebral perfusion (SCP) has been used in aortic arch surgical procedures, the core temperature during lower body circulatory arrest (LBCA) has been steadily rising. Simultaneously, the use of a frozen elephant trunk (FET) graft has been increasing. The safe period of LBCA in relation to spinal cord ischaemic tolerance in combination with segmental artery occlusion by the FET procedure has not been defined.

Methods: Sixteen pigs were assigned to undergo 65 (n = 10) or 90 min (n  = 6) of SCP at 28°C with LBCA in combination with occlusion of the 8 uppermost segmental arteries in the thoracic (Th) aorta (15–20 cm FET, Th8-level). The follow-up period consisted of a 6-h intensive period and a 5-day observation period. Near-infrared spectroscopy of the collateral network was used to determine spinal cord oxygenation. The neurological status of the patients was evaluated daily, and the brain and the spinal cord were harvested for a histopathological analysis.

Results: Five out of 6 pigs after 90 min and 1 out of 10 pigs after 65 min of LBCA died within 48 h of multiorgan failure. Of the survivors in the 65-min group, 6 out of 9 had paraparesis/paraplegia; the remaining 3 reached normal function. The lone survivor after 90 min of LBCA was paraplegic. Nadir near-infrared spectroscopy of the collateral network values at Th8 and Th10 were 34 (±5) and 39 (±4), and they were reached within 35 min of SCP in both groups.

Conclusions: An extended FET graft with LBCA and SCP durations >65 min at 28°C results in a poor outcome.

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Series: Interactive cardiovascular and thoracic surgery
ISSN: 1569-9293
ISSN-E: 1569-9285
ISSN-L: 1569-9293
Volume: 34
Issue: 1
Pages: 145 - 152
DOI: 10.1093/icvts/ivab219
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.