Antegrade cerebral perfusion with cold blood: a 13-year experience

Bachet, Jean; Guilmet, D; Goudot, B; Dreyfus, Gilles; Delentdecker, Philippe; Brodaty, D; Dubois, Claude

doi:10.1016/s0003-4975(99)00411-7

Cited by 239 publications

(140 citation statements)

References 13 publications

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“…55 , a temperatura do paciente é mantida em 25ºC durante a PCC, parte do sangue do oxigenador é resfriado entre 6 e 12ºC, e infundido diretamente nas carótidas a um fluxo de 200 a 250 ml/min., e com uma pressão de 60 a 70 mmHg. Entre 1984 e 1998, os autores utilizaram PCC e cerebroplegia em 171 casos de substituição do arco aórtico, 42 dos quais devido a dissecções tipo A; o tempo médio de CEC foi de 121min, o tempo médio de perfusão cerebral seletiva 60min, a mortalidade hospitalar 17%, e a ocorrência de dano neurológico pós-operatório 13% 56 . Embora outros estudos também sugiram superioridade da perfusão anterógrada sobre a RPC e a PCC hipotérmica, tanto em nível clínico 51,57 como experimental 52 , complicações como sangramento nos sítios de canulação e hemorragia intracerebral têm restringido seu uso a poucos centros.…”

Section: Dissecções Agudas Da Aortaunclassified

Diretrizes para a cirurgia das doenças da aorta

Albuquerque¹,

Palma²,

Braile³

et al. 2004

Arq. Bras. Cardiol.

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Section: Dissecções Agudas Da Aortaunclassified

Diretrizes para a cirurgia das doenças da aorta

Albuquerque¹,

Palma²,

Braile³

et al. 2004

Arq. Bras. Cardiol.

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“…The indications for emergent aortic arch surgery are: acute aortic dissection located within the arch, aortic rupture, false aneurysm, and impending dissection (penetrating aortic ulcer and intramural haematoma). Development of aortic arch surgery techniques was possible due to improvement of protection and monitoring of the central nervous system (CNS) [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Single-centre experience in surgery of acute aortic type A dissection and true aortic arch aneurysm

et al. 2016

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A b s t r a c tBackground: Surgery of the aortic arch is challenging. Aim:To assess the results of aortic arch surgery. Methods:Analysis of 172 patients operated on arch dissection (emergency group: 97 patients) or aneurysm (elective group: 75 patients) between 2007 and 2014. Arch surgery was defined as a procedure requiring circumferential anastomosis at the level of the aortic arch or the descending aorta with the use of techniques of brain protection (deep hypothermic circulatory arrest [DHCA] or selective antegrade cerebral perfusion [SACP]) and/or debranching of at least one supra-aortic vessel.Results: Men predominated in both groups (> 70%). Men were younger in the emergency group (55 vs. 66 years; p < 0.008). The operative risk was higher in the emergency group (19.2% vs. 12.5%; p < 0.001). Forty-nine per cent of the patients from the emergency group and 5% from the elective group were operated with antiplatelet therapy (p < 0.001). Extended hemiarch procedure was performed in 79% (n = 77) in the emergency and 76% (n = 57) in the elective group. Total arch replacement was performed in 19 (21%) patients from the emergency and 18 (24%) patients from the elective group. In these patients debranching was performed in 68% of the emergency patients group and in 67% of the elective group. Elephant trunk procedure (classic/frozen) was performed in 53% (n = 10) from the emergency and in 78% (n = 14) of patients from the elective group. Aortic valve sparing surgery was performed in 20% of patients from the emergency and 9% from the elective group (p = 0.063). DHCA was performed in 58% (n = 43) of patients from the elective group and 39% (n = 37) from the emergency group. SACP was performed in 61% (n = 58) of patients from the emergency and 42% (n = 31) from the elective group. Thirty-day mortality in the emergency group reached 33% (n = 32), and in the elective group 15% (n = 11; p = 0.007). In multivariate analysis, predictors of death in the emergency group were: Logistic EuroSCORE above 19.5%, extracorporeal circulation time above 228 min, and postoperative acute renal failure (ARF); and in the elective group: DHCA time above 26 min, rethoracotomy due to bleeding, and ARF. Follow-up was completed in 100% of patients in terms of vital status. The mean follow-up time of the patients from the emergency group was 24.3 ± 27.10 (min 0, max 92) months, and from the elective group 30.3 ± 24.5 (min 0, max 99) months. During the follow-up period all-cause mortality in the emergency group was 43% (n = 42/97), and in the elective group it was 36% (n = 27/75). Conclusions:Early mortality in the emergency group was higher, while long-term mortality did not differ among the groups. Postoperative ARF is a critical predictor of mortality in both groups.

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“…The patient was considered to be at extremely high risk of additional cerebral deficits during total arch replacement. Bachet 8) and Kazui 9) demonstrated the superiority of SCP for cerebral protection during aortic arch repair. However, Kazui reported that an old cerebral infarction is a significant risk factor for neurological dysfunction, even with SCP and deep hypothermia.…”

Section: Discussionmentioning

confidence: 99%