Advances in brain and spinal cord protection in aortic surgery
Dr. Safi received the award for developing innovative techniques for cerebral and spinal cord protection during thoracic aortic surgery and then rigorously proved their therapeutic benefit. Although methods to maintain blood supply to the brain and spinal cord have greatly improved, ischemic insults to the brain and spinal cord have long plagued aortic surgery. Profound hypothermia and circulatory arrest were a great leap forward and ascending and arch surgery became commonplace. However, utilizing profound hypothermic circulatory arrest at greater than 40 minutes cross-clamp increases the incidence of stroke; cross-clamp times greater than 65 minutes are associated with an increase in death. Dr. Safi tested retrograde cerebral perfusion and demonstrated its efficacy in a porcine model. Subsequently, using this technique, he showed a reduction in the incidence of stroke in a clinical trial. Current plans are underway for a randomized trial comparing retrograde and antegrade cerebral perfusion in surgery of the ascending and transverse arch. Since the inception of surgical repair of thoracoabdominal aortic aneurysm under cardiopulmonary bypass and passive shunt through the 1970’s, neurologic deficit for this procedure was relatively high. Although utilization of individuals adjuncts met with limited success, synergistic use of CSF drainage and distal aortic perfusion has virtually eliminated paraplegia in Type I and DTAA and markedly reduced neurologic morbidity in Type II TAAA.
Dr. Safi’s nomination was based on the following publications:
Safi HJ, Letsou GV, Iliopoulos DC, Subramaniam MH, Miller CC 3rd, Hassoun H, Asimacopoulos PJ, Baldwin JC. Impact of retrograde cerebral perfusion on ascending aortic and arch aneurysm repair. Ann Thorac Surg. 1997 Jun;63(6):1601-7.
Safi HJ, Campbell MP, Miller CC 3rd, Iliopoulos DC, Khoynezhad A, Letsou GV, Asimacopoulos PJ. Cerebral spinal fluid drainage and distal aortic perfusion decrease the incidence of neurological deficit: the results of 343 descending and thoracoabdominal aortic aneurysm repairs. Eur J Vasc Endovasc Surg. 1997 Aug;14(2):118-24.