Peer- reviewed Scientific Publications
Project Publications (H2020)
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Ann Cardiothorac Surg. 2023 Sep 28; 12(5): 492–499.
'Operative Technique' article in the 'Spinal Cord Protection' focussed issue of the Annals of Cardiothoracic Surgery describing the techniques involved in the MIS²ACE procedure which is at the centre of the PAPAartis trial.
Rationale of the PAPAartis trial
Ann Cardiothorac Surg. 2023 Sep 28; 12(5): 463–467.
Keynote lecture in the 'Spinal Cord Protection' focussed issue of Annals of Cardiothoracic Surgery describing the background and rationale of the PAPAartis trial with an update on current status (September 2023). Initial results are promising and suggest that the MIS²ACE concept can significantly reduce spinal cord injury in patients undergoing open or endovascular treatment for various thoracoabdominal pathologies.
Cost Eff Resour Alloc 2022; 20:18
Review of methods for handling missing data with the aim of identifying the best method for use in the health economic analysis planned in the PAPAartis study .
Contemp Clin Trials Commun 2022 Sep 3; 29:100987.
Publication of the first results of the qualitative analysis of patient experience and decision making during their participation in the PAPAartis clinical trial.
Eur J Cardiothorac Surg. 2021 Sep 11;60(3):569-576
Publication indicating that protective distal aortic perfusion during thoraco-abdominal aortic repair may be associated with inadequate spinal protection particularly at the mid-thoracic spinal cord level and result in the adverse effect of a potentially dangerous hyperperfusion of the distal spinal cord segments.
Eur J Cardiothorac Surg. 2020 Sep 1;58(3):629-637.
Publication showing it is possible to detect three markers of SCI in experimental models and in a small number of patients using microdialysis. This supports a subproject of PAPAartis aiming to identify clinically relevant markers of SCI in CSF to develop a bed-side test.
Paraplegia prevention in aortic aneurysm repair by thoracoabdominal staging with ‘minimally invasive staged segmental artery coil embolisation’ (MIS²ACE): trial protocol for a randomised controlled multicentre trial
Publication of the clinical trial protocol which is the basis of the PAPAartis project
Project Publications (DFG)
J Thorac Cardiovasc Surg. 2022 Jul;164(1):e3-e15.
Study to identify the optimal cnNIRS positioning in an acute large animal model for routine clinical use. The results support the potential for near-infrared spectroscopy to be used as a non-invasive method to monitor oxygen levels during aortic procedures, with further work necessary to translate the work from lab to clinic.
Ann Thorac Surg. 2022 May;113(5):1692-1702
Review outlining the current state of art in the field of spinal cord injury research.
J Cardiovasc Surg (Torino). 2021 Aug;62(4):316-325
Review article discussing established and novel adjuncts for spinal cord protection, including priming and preconditioning of the paraspinal collateral network, intraoperative systemic hypothermia, distal aortic perfusion, motor- and somatosensory evoked potentials and noninvasive cnNIRS monitoring as well as peri- and postoperative drainage of cerebrospinal fluid.
Eur J Cardiothorac Surg. 2021 Jul 14;60(1):48-55.
Evaluation of collateral network near-infrared spectroscopy to guide minimally invasive segmental artery occlusion to prevent paraplegia associated with extensive aortic procedures. The study showed collateral network near-infrared spectroscopy-guided segmental artery occlusion is feasible and may become a useful adjunct facilitating adequate and complete vessel occlusion.
J Surg Case Rep. 2021 May 8;2021(5):rjab174.
Case report of first use of collateral network near-infrared spectroscopy to non-invasively monitor spinal cord oxygenation during a frozen elephant trunk procedure to document mid-thoracic paraspinous oxygenation levels. Future experimental and clinical studies are warranted in order to evaluate bilateral collateral network near-infrared spectroscopy from the mid-thoracic region downward, including arch procedures with frozen elephant trunk and different strategies in arterial perfusion.
J Vis Exp. 2020 Dec 10;(166)
Study describing a standardized protocol for real-time spinal cord microcirculatory evaluation using laser-Doppler needle probes directly inserted in the spinal cord. Results using a porcine model of ischemia/reperfusion showed the feasibility of this method.
Eur J Cardiothorac Surg. 2019 Jul 1;56(1):126-134.
Study to identify the optimal MIS²ACE occlusion pattern for spinal cord injury prevention prior to open or endovascular thoraco-abdominal aortic aneurysm repair. Concluded that a regional-based occlusion pattern (starting with the lumbar segmental arteries) seems to be the best 2-stage approach.
J Thorac Cardiovasc Surg. 2019 Jul;158(1):155-164.e5.
Study evaluating collateral network near-infrared spectroscopy during and after segmental artery occlusion in a chronic porcine model. the data suggest that collateral network near-infrared spectroscopy may be a valuable noninvasive tool for detecting imminent spinal cord ischemia during and after aortic procedures involving segmental artery occlusion.
EuroIntervention. 2018 Sep 20;14(7):828-835.
Publication of the results of the first clinical experience of using MIS²ACE, demonstrating that the procedure is feasible and has a promising safety profile.
J Thorac Cardiovasc Surg. 2015 Apr;149(4):1074-9.
Publication of the results of the first-in-man experience using minimally invasive, selective segmental artery endovascular coil embolization before aortic aneurysm repair. This showed the procedure is clinically feasible and may eventually eliminate ischaemic spinal cord injury. These results inspired the concept of the PAPAartis project - to test this strategy in a randomised controlled multicentre clinical trial.
J Thorac Cardiovasc Surg 2015 Apr;149(4):1079-80.
Editorial comment on the paper below. The editors highlight the need for staged repairs of aortic aneurysms to be at the forefront of the minds of those carrying out aneurysm repairs and describe the strategy to be tested in PAPAartis as 'exposing a new frontier in managing and preventing spinal cord injury'.
Interviews and Non peer-reviewed Publications