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Peer- reviewed Scientific Publications

Project Publications (H2020)

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Minimally invasive staged segmental artery coil embolization (MIS²ACE) for spinal cord protection

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.

Comparing methods for handling missing cost and quality of life data in the Early Endovenous Ablation in Venous Ulceration trial. 

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 .

“There is nothing better than participating in this study”: Living the PAPAartis cardiovascular randomised controlled trial

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.

Effect of cerebrospinal fluid pressure elevation on spinal cord perfusion during aortic cross-clamping with distal aortic perfusion

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.

Near real-time bedside detection of spinal cord ischaemia during aortic repair by microdialysis of the cerebrospinal fluid

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.

Project Publications (DFG)

Mapping the collateral network: Optimal near-infrared spectroscopy optode placement

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.

Ischemic Spinal Cord Injury-Experimental Evidence and Evolution of Protective Measures

Ann Thorac Surg. 2022 May;113(5):1692-1702

Review outlining the current state of art in the field of spinal cord injury research.

Spinal cord protection in thoracoabdominal aortic aneurysm surgery: a multimodal approach

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.

Experimental near-infrared spectroscopy-guided minimally invasive segmental artery occlusion 

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.

Spinal cord monitoring using collateral network near-infrared spectroscopy during extended aortic arch surgery with a frozen elephant trunk

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.

Real-Time Assessment of Spinal Cord Microperfusion in a Porcine Model of Ischemia/Reperfusion

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.

Optimal occlusion pattern for minimally invasive staged segmental artery coil embolization in a chronic porcine model 

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.

Evaluation of collateral network near-infrared spectroscopy during and after segmental artery occlusion in a chronic large animal model

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.

Background Publications

Ischaemic preconditioning of the spinal cord to prevent spinal cord ischaemia during endovascular repair of thoracoabdominal aortic aneurysm: first clinical experience

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.

First-in-man endovascular preconditioning of the paraspinal collateral network by segmental artery coil embolization to prevent ischemic spinal cord injury

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. 

Setting the stage: Thoracoabdominal aortic aneurysm repair in 2 acts

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

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