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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2000 February;41(1):89-93

language: English

Iloprost protects the spinal cord during aortic cross-clamping in a canine model

Katircioglu S. F., Ulus A. T., Gökce P. *, Sürücü S. **

From the ­Türkiye ­Yüksek ­Ihtisas Hos­pital Car­di­o­vas­cular Sur­gery ­Clinic, ­Ankara, ­Turkey
*­Ankara Uni­ver­sity Vet­e­ri­narian ­Faculty, ­Ankara, ­Turkey
**Depart­ment of ­Anatomy Hacet­tepe Uni­ver­sity of ­Ankara, ­Turkey


Back­ground. Sur­gical pro­ce­dures on the thor­a­coab­dom­inal ­part of the ­aorta ­make the ­spinal ­cord vul­ner­able to ­ischemia. Par­a­plegia is the ­most ­severe com­pli­ca­tion fol­lowing thor­a­coab­dom­inal oper­a­tions. In ­this ­study, ilo­prost was ­used as an ­agent to ­decrease the ­severity of ­ischemia and reper­fu­sion ­injury to the ­spinal ­cord ­during ­aortic occlu­sion and ­declamping.
­Methods. ­Twelve ­adult mon­grel ­dogs ­weighing 17±2 kg ­were ­used in ­this ­study. The ani­mals ­were ran­domly ­assigned to ­either ­group I, ­which ­received ­saline solu­tion (6 ­dogs), or ­group II, ­which ­received pros­tac­y­clin. ­Group I was ­referred to as the con­trol ­group and ­group II as the ilo­prost ­group. ­After base­line meas­ure­ments ­were com­pleted, the ­aorta was ­cross-­clamped for ­sixty min­utes ­distal to the ­left sub­cla­vian ­artery. No phar­mac­o­logic ­agents ­were ­used to con­trol ­blood pres­sure in ­group I. Prox­imal and ­distal ­mean arte­rial pres­sures (­DMAP) ­were mon­i­tored con­tin­u­ously. ­DMAP ­were con­sid­ered as dia­stolic pres­sure in pre­oc­clu­sion and reper­fu­sion ­periods. Ilo­prost admin­is­tra­tion was ­started at a ­rate of 5 ng/kg/­minute ­five min­utes ­before the ­aortic occlu­sion. ­This ­dosage was ­increased to 25 ng/kg/­minute ­during ­aortic occlu­sion.
­Results. ­Mean prox­imal arte­rial pres­sure was 147±12 ­mmHg in the con­trol ­group and 116±13 ­mmHg in the ilo­prost ­group at occlu­sion (p<0.01). ­Mean ­distal arte­rial pres­sure was 19±7 in the con­trol ­group and 37±5 in the ilo­prost ­group ­during ­clamping (p<0.05). Func­tional out­come was eval­u­ated ­according to ­Tarlov ­scores 24 ­hours ­after the ­study. ­Although ­none of the ani­mals recov­ered com­pletely ­from the con­trol ­group, 4 ani­mals ­from the ilo­prost ­group recov­ered (p<0.05). Fol­lowing the neu­ro­logic assess­ment, ani­mals ­were sac­ri­ficed and spec­i­mens ­were ­taken for the elec­tron micro­scopic ­study. Elec­tron micro­scopic ­changes doc­u­mented ­that ­severe mit­o­chon­drial ­damage and vac­uol­isa­tion ­occurred in the con­trol ­group. How­ever ­these ­changes ­were ­more ­subtle in the ilo­prost ­group.
Con­clu­sions. As a ­result of ­this ­study we con­cluded ­that ilo­prost ­infused ­before and ­during ­clamping of the tho­racic ­aorta mit­i­gates the ­spinal ­cord ­injury due to ­ischemia and reper­fu­sion fol­lowing ­unclamping.

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