Background: In clinical and basic science medicine, we often isolate ourselves in silos, unaware of developments in other related disciplines. Our team has had substantial experience, both in the operating room and in the laboratory, with protecting the brain and the spinal cord via hypothermia. Herein, we briefly share this experience with our colleagues in Neurology, eager for comments and advice from the neurologic perspective. Methods: 1) Clinical brain protection via deep hypothermic circulatory arrest (DHCA) for surgery of the aortic arch. For aortic arch replacement (performed for aortic arch aneurysm or aortic dissection), the aortic arch must be opened and native perfusion stopped. We have decades of experience in many hundreds of patients with this technique. This experience is reviewed. 2) Experimental protection of the spinal cord via cooling. We review our laboratory experience with a novel, recirculating cooling catheter for the vulnerable spinal cord. 3) Experimental protection of the brain via an intraventricular cooling catheter. We review our laboratory experience cooling the brain with a balloon-tipped catheter residing the lateral ventricles. Results: 1) Deep hypothermic circulatory arrest for aortic arch surgery provides superb brain protection for periods up to 45 minutes or longer. Clinical neurologic function, and quantitative neurologic tests, show excellent brain preservation. 2) The novel spinal cooling catheter provides excellent cooling of the spinal cord in a large animal model, without apparent injury of any type. 3) The intraventricular brain cooling catheter provides excellent cooling of the brain, documented by both direct temperature probe and high-tech brain imaging. Conclusions: We wish herein (in this article) to share this experience across our disciplines (Cardiac Surgery and Neurology). We welcome advice from the Neurology community on these surgically-directed methods for cooling and protection of neurological tissue in both the brain and the spinal cord.
References
[1]
BBC Horizons (2010) Back from the Dead. UK. Video Presentation.
[2]
The Science Channel (2012) Through the Wormhole with Morgan Freeman. USA. Video Presentation.
[3]
RAI Voyager (2011) Italy. Video Presentation.
[4]
Leshnower, B.G., Rangaraju, S., Allen, J.W., Stringer, A.Y., Gleason, T.G. and Chen, E.P. (2019) Deep Hypothermia with Retrograde Cerebral Perfusion versus Moderate Hypothermia with Antegrade Cerebral Perfusion for Arch Surgery. The Annals of Thoracic Surgery, 107, 1104-1110. https://doi.org/10.1016/j.athoracsur.2018.10.008
[5]
Kirklin, J.W. and Barrett-Boyes, B.G. (1993) Cardiac Surgery: Morphology, Diagnostic Criteria, Natural History, Techniques, Results, and Indications. 2nd Edition, Churchill Livingston, New York.
[6]
Griepp, R., Girepp, R.B., Stinson, E.B., Hillingsworth, J.F. and Buehler, D.G. (1975) Prosthetic Replacement of the Aortic Arch. The Journal of Thoracic and Cardiovascular Surgery, 70, 1051-1063. https://doi.org/10.1016/S0022-5223(19)39653-9
[7]
Gega, A., Rizzo, J.A., Johnson, M.H., Tranquilli, M., Farkas, E.A. and Elefteriades, J.A. (2007) Straight Deep Hypothermic Arrest: Experience in 394 Patients Supports Its Effectiveness as a Sole Means of Brain Preservation. The Annals of Thoracic Surgery, 84, 759-766. https://doi.org/10.1016/j.athoracsur.2007.04.107
[8]
Percy, A., Widman, S., Rizzo, J.A., Tranquilli, M. and Elefteriades, J.A. (2009) Deep Hypothermic Circulatory Arrest in Patients with High Cognitive Needs: Full Preservation of Cognitive Abilities. The Annals of Thoracic Surgery, 87, 117-123. https://doi.org/10.1016/j.athoracsur.2008.10.025
[9]
Chau, K.H., Friedman, T., Tranquilli, M. and Elefteriades, J.A. (2013) Deep Hypothermic Circulatory Arrest Effectively Preserves Neurocognitive Function. The Annals of Thoracic Surgery, 96, 1553-1559. https://doi.org/10.1016/j.athoracsur.2013.06.127
[10]
Ziganshin, B.A., Elefteriades, J.A., et al. (2014) Straight Deep Hypothermic Circulatory Arrest for Cerebral Protection during Aortic Arch Surgery: Safe and Effective. The Journal of Thoracic and Cardiovascular Surgery, 148, 888-900. https://doi.org/10.1016/j.jtcvs.2014.05.027
[11]
Damberg, A., Carino, D., Charilaou, P., Peterss, S., Tranquilli, M., Ziganshin, B.A., Rizzo, J.A. and Elefteriades, J.A. (2017) Favorable Late Survival after Aortic Surgery under Straight Deep Hypothermic Circulatory Arrest. The Journal of Thoracic and Cardiovascular Surgery, 154, 1831-1839.e1. https://doi.org/10.1016/j.jtcvs.2017.08.015
[12]
Cambria, R.P., Davison, J.K., Carter, C., Brewster, D.C., Chang, Y., Clark, K.A. and Atamian, S. (2000) Epidural Cooling for Spinal Cord Protection during Thoracoabdominal Aneurysm Repair: A Five-Year Experience. Journal of Vascular Surgery, 31, 1093-1102. https://doi.org/10.1067/mva.2000.106492
[13]
Zhu, L. (2018) Hypothermia Used in Medical Applications for Brain and Spinal Cord Injury Patients. In: Fu, B. and Wright, N., Eds., Molecular, Cellular, and Tissue Engineering of the Vascular System, Advances in Experimental Medicine and Biology, Vol. 1097, Springer, Cham, 295-319.
[14]
Walsh, J.J., Huang, Y., Simmons, J.W., et al. (2020) Dynamic Thermal Mapping of Localized Therapeutic Hypothermia in the Brain. Journal of Neurotrauma, 37, 55-65. https://doi.org/10.1089/neu.2019.6485
[15]
Moomiaie, R.M., Gould, G., Solomon, D., Simmons, J., Kim, J., Botta, D. and Elefteriades, J.A. (2012) Novel Intracranial Brain Cooling Catheter to Mitigate Brain Injuries. Journal of NeuroInterventional Surgery, 4, 130-133. https://doi.org/10.1136/jnis.2010.004432
