Commentary: A little help from the bench to cut risk of paraplegia?

See Article page e90.Central MessagePreventing spinal cord deficit requires a multimodal approach. e90. Preventing Although open aortic repair is associated with substantial postoperative complications, (ie, paraplegia and paraparesis) may be the most devastating one. Regarding Crawford's lifetime experience 1509 thoracoabdominal aneurysm (TAAA) repairs, as presented in late 1990s by Svensson colleagues,1Svensson L.G. Crawford E.S. Hess K.R. Coselli J.S. Safi H.J. Experience patients undergoing operations.J Vasc Surg. 1993; 17 (discussion 68-70): 357-368Abstract Full Text PDF PubMed Scopus (1119) Google Scholar rate of was staggering 31% after extensive form such repair, extent II TAAA repair. Since era, rates have dramatically decreased; temporary permanent were 2.4% 5.4%, respectively, across all extents for 8.0%.2Coselli LeMaire S.A. Preventza O. de la Cruz K.I. Cooley D.A. Price M.D. et al.Outcomes 3309 repairs.J Thorac Cardiovasc 2016; 151: 1323-1337Abstract (384) How surgeons able to reduce likelihood developing deficit? There has been an ongoing refinement surgical technique that based on recognition protecting essential preventing paralysis; these efforts resulted gradual improvements contemporary outcomes many centers.3Gaudino M. Khan F.M. Rahouma Naik A. Hameed I. Spadaccio C. al.Spinal injury endovascular descending thoracic aneurysms: meta-analysis.J May 13, 2020; ([Epub ahead print])Abstract (17) The use approach4MacArthur R.G. Carter Organ protection during surgery: rationale multimodality approach.Semin Cardiothorac Anesth. 2005; 9: 143-149Crossref (49) includes cerebrospinal fluid drainage, left heart bypass, maintaining adequate mean arterial pressure, revascularization intercostal arteries,5Coselli Green S.Y. Zhang Q. 1114 February 12, 2019; print])Google well additional measures6Parotto Ouzounian Djaiani G. Spinal elective procedures.J 33: 200-208Abstract (12) include motor-evoked potential monitoring,7Tanaka Y. Kawaguchi Noguchi Yoshitani K. Kawamata Masui al.Systematic review motor evoked potentials monitoring diagnostic 30: 1037-1050Crossref (34) systemic or targeted hypothermia, intrathecal papaverine drainage,8Svensson D'Agostino R.S. Entrup M.H. Hreib Kimmel W.A. al.Reduction neurologic high-risk operation.Ann 1998; 66: 132-138Abstract (156) other pharmacologic agents,9Wynn M.M. Acher C.W. A modern theory ischemia/injury surgery its implications prevention paralysis.J 2014; 28: 1100-1111Abstract appears collectively reduced risk paraplegia. Furthermore, adjuncts adopted which also carries enhanced but without simple methods revascularize arteries. In this issue Journal, Ikeno colleagues10Ikeno Ghincea C.V. Roda G.F. Cheng L. Aftab Meng X. al.Direct indirect activation ATP-sensitive potassium channel induce metabolic tolerance ischemia-reperfusion injury.J 2023; 165: e90-e99Abstract (4) from University Colorado explore pharmacologically induced using murine model. Specifically, several robust models, they investigate role direct mitochondrial channels ischemia. Mice pretreated 3-day course different combinations pharmaceutical agents (eg, nicorandil, diazoxide, carboxy-PTIO), followed inducing ischemia through crossclamping aorta 7 minutes. Results measured functional tests immunohistochemistry impressive—nicorandil significantly preserved function. However, questions remain. First, age tested mice young 3-4 months old), we know, distal tend older. Younger physiology than older ones, not mention lack atherosclerotic plaque so prevalent typical Second, experiments conducted normothermic circumstances (37°C-38°C), whereas repairs are performed under mildly hypothermic (32°C) profoundly (≤18°C) conditions. Temperature well-established influence change cellular metabolism acutely sensitive tissue cord. Third, authors studied one mode development deficit—the ischemic–reperfusion pathway; clinical practice, multifaceted involves ischemic embolic pathways present immediately delayed fashion (within few days initially being determined free any related concern). Postoperative complex; life-altering complication necessitates multiple strategies. recent decades, there remains duty further decrease debilitating complication. nicorandil effective mitigating welcome addition existing Attempts define preventative measures possible interesting venue investigation. Nicorandil promising armamentarium very practical applications reducing thank Susan Green, MPH, Baylor College Medicine, providing editorial support. Direct adenosine triphosphate–sensitive toleranceThe Journal Thoracic Cardiovascular SurgeryVol. 165Issue 3PreviewThe central injury. We hypothesized both nitric oxide–dependent contribute induction tolerance. Full-Text