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J Thorac Cardiovasc Surg 2006;132:1150-1155
© 2006 The American Association for Thoracic Surgery

Evolving Technology

Transcutaneous near-infrared spectroscopy for detection of regional spinal ischemia during intercostal artery ligation: Preliminary experimental results

Scott A. LeMaire, MDa,d,*, Lyssa N. Ochoa, MDd, Lori D. Conklin, MDd, Ron A. Widmanf, Fred J. Clubb, Jr, DVM, PhDb, Akif Ündar, PhDc,e, Zachary C. Schmittling, MDd, Xing Li Wang, MD, PhDd, Charles D. Fraser, Jr, MDa,e, Joseph S. Coselli, MDa,d

a Cardiovascular Surgery Service, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex
b Department of Cardiovascular Pathology, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex
c Cullen Cardiovascular Surgical Research Laboratories, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex
d Divisions of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
e Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
f Somanetics Corporation, Troy, Mich.

Received for publication March 8, 2006; revisions received April 27, 2006; accepted for publication May 8, 2006.

* Address for reprints: Scott A. LeMaire, MD, One Baylor Plaza, BCM 390, Houston, TX 77030 (Email: slemaire{at}bcm.tmc.edu).

OBJECTIVE: Real-time information about regional spinal cord ischemia can guide intraoperative management and reduce the risk of paraplegia after thoracic aortic surgery. We hypothesized that near-infrared spectroscopy could provide such information during intercostal and lumbar artery ligation in pigs.

METHODS: Transcutaneous near-infrared spectroscopic sensors were placed in the midline over the upper and lower thoracic vertebrae of 4 progressively larger pigs (weight range 21-70 kg). After the entire aorta was exposed, segmental arteries from T6 through L1 were sequentially ligated while regional oxygen saturation was monitored. Decreases in regional oxygen saturation were calculated as percentage changes from baseline. The degrees of ischemia in the upper and lower spinal cord were compared histopathologically.

RESULTS: Baseline regional oxygen saturations were similar in the upper (68.8% ± 9.0%) and lower (68.0% ± 11.5%, P = .82) cord. After ligation, however, regional oxygen saturation levels were significantly lower in the lower cord (41.3% ± 10.1%) than in the upper cord (64.8% ± 9.3%, P = .037). The regional oxygen saturation had decreased by 39.0% ± 11.5% in the lower cord but only by 6.3% ± 7.6% in the upper cord (P = .026). This difference was confirmed microscopically: upper-cord sections had fewer ischemic neurons (8.8 ± 9.4) than did lower-cord sections (21.3 ± 13.6, P = .002).

CONCLUSION: Intraoperative spinal cord ischemia was detectable with near-infrared spectroscopy in pigs weighing as much as 70 kg. The potential utility of this technique in patients undergoing thoracic aortic surgery warrants investigation.

Abbreviations and Acronyms MEP = motor-evoked potential; NIRS = near-infrared spectroscopy; SrO 2 = regional spinal oxygen saturation; SSEP = somatosensory-evoked potential; TAAA = thoracoabdominal aortic aneurysm




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