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J Thorac Cardiovasc Surg 2004;128:724-730
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Superiority of early relative to late ischemic preconditioning in spinal cord protection after descending thoracic aortic occlusion

^a Departments of Cardiothoracic Surgery, School of Medicine, University of Ioannina, Ioannina, Greece
^b Department of Surgery–Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
^c Department of Pathology, School of Medicine, University of Ioannina, Ioannina, Greece
^d Columbia University College of Physicians and Surgeons, St Luke's–Roosevelt Hospital Center, New York, NY

Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25-28, 2004.

Received for publication April 23, 2004; revisions received June 7, 2004; accepted for publication June 23, 2004.

^* Address for reprints: Constantine E. Anagnostopoulos, MD, St. Luke's–Roosevelt Hospital Center at Columbia University, 45 E 89th St, New York, NY 10128 (E-mail: cea8{at}columbia.edu).

OBJECTIVE: We previously showed that ischemic preconditioning significantly reduced spinal cord injury caused by 35-minute aortic occlusion. In this study we investigated the effect of ischemic preconditioning on spinal cord injury after 45-minute aortic occlusion.

METHODS: Thirty-two pigs were divided as follows: group 1 (n = 6) underwent sham operation, group 2 (n = 6) underwent 20 minutes of aortic occlusion, group 3 (n = 6) underwent 45 minutes of occlusion, group 4 (n = 6) underwent 20 minutes of occlusion and 48 hours later underwent an additional 45 minutes, and group 5 (n = 8) underwent 20 minutes of occlusion and 80 minutes later underwent an additional 45 minutes. Aortic occlusion was accomplished with two balloon occlusion catheters placed fluoroscopically after the origin of the left subclavian artery and at the aortic bifurcation. Neurologic evaluation was by Tarlov score. The lower thoracic and lumbar spinal cords were harvested at 120 hours and examined histologically with hematoxylin-eosin staining. The number of neurons was counted, and the inflammation was scored (0-4). Statistical analysis was by Kruskal-Wallis and 1-way analysis of variance tests.

RESULTS: Group 5 (early ischemic preconditioning) had better Tarlov scores than group 3 (P< .001) and group 4 (late ischemic preconditioning, P< .001). The histologic changes were proportional to the Tarlov scores, with the least histologic damage in the animals of group 5 relative to group 3 (number of neurons P< .001, inflammation P= .004) and group 4 (number of neurons P< .001, inflammation P= .006).

CONCLUSION: Early ischemic preconditioning is superior to late ischemic preconditioning in reducing spinal cord injury caused by the extreme ischemia of 45 minutes of descending thoracic aortic occlusion.

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