Antegrade Versus Retrograde Cerebral Perfusion in Relation to Postoperative Complications Following Aortic Arch Surgery for Acute Aortic Dissection Type A

Apostolakis, Efstratios; Koletsis, Efstratios; Dedeilias, Panagiotis; Kokotsakis, John; Sakellaropoulos, George; Psevdi, Argini; Bolos, Konstantin; Dougenis, Dimitrios

doi:10.1111/j.1540-8191.2008.00587.x

Cited by 50 publications

(37 citation statements)

References 37 publications

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“…If the carotids are severely destroyed by dissection, retrograde cerebral perfusion may be considered as an option, so long carotids are replaced by tube grafts. However, retrograde cerebral perfusion is associated with a significantly higher incidence of temporary neurological complications, later extubation, longer ICU-stay, hospitalization, than ACP [34]. In a study of 4670 patients who underwent extensive aortic surgery between 1985 and 2002 at the Heart Centre Leipzig, Germany, superiority of ACP over retrograde cerebral perfusion or stand-alone deep hypothermia was confirmed.…”

Section: Cerebral Protection In Dissection Surgerymentioning

confidence: 94%

Recent Advances in the Management of Acute Aortic Syndrome

Göbölös¹,

Foltan²,

Ugocsai³

et al. 2012

Front Lines of Thoracic Surgery

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Section: Cerebral Protection In Dissection Surgerymentioning

confidence: 94%

Recent Advances in the Management of Acute Aortic Syndrome

Göbölös¹,

Foltan²,

Ugocsai³

et al. 2012

Front Lines of Thoracic Surgery

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“…B. über eine V. jugularis als auch die ante grade SCP wurden eingesetzt. Da die Pa tienten in klinischen Studien von der re trograden SCP nicht profitieren konn ten [4,24] [25,29,40]. Ein Perfu sionsdruck von 70 mmHg sollte zur Ver meidung eines Hirnödems, sofern mög lich, nicht überschritten werden [3].…”

Section: Selektive Zerebrale Perfusionunclassified

Typ-A-Dissektion

Roggenbach

Rauch

2010

Anaesthesist

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Acute type A dissection is among the most dangerous of vascular diseases and is associated with a high lethality. Surgery for type A dissection is a complex procedure which is accompanied by relevant blood losses and severe deterioration of the coagulation system. Either due to the dissection or the surgical procedure, perfusion of affected organs can be diminished or completely disrupted with the risk of irreversible organ damage especially in the brain. Perioperative anesthesiological management for type A dissection is demanding and involves maintaining hemodynamic stability, surveillance of cerebral oxygenation and transesophageal echocardiographical diagnostic support for the decision-making of the most appropriate surgical approach. Furthermore, reestablishment of sufficient hemostasis can be challenging and requires thorough understanding of the relevant aspects affecting normal hemostasis during surgical repair of aortic dissection. In this article relevant pathophysiological aspects and basic principles of anesthesiological management of type A dissection are described.

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“…However, recent data show that more and more elderly patients undergo cardiac surgery for diseases of the aorta [38] . Better outcome of cardiac operations in octogenarians due to medical progress has resulted in an increased number of referrals of elderly patients for aortic surgery [39] .These measures make aortic surgery much safer. Therefore, it seems reasonable to offer aortic surgery also to elderly patients.…”

Section: Aortic Surgerymentioning

confidence: 99%

The Elderly Patient and Cardiac Surgery – A Mini-Review

Wiedemann

Bernhard²,

Laufer³

et al. 2009

Gerontology

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Introduction: Due to the increase in average life expectancy and the higher incidence of cardiovascular disease with advancing age, more elderly patients present for cardiac surgery nowadays. Advances in pre- and postoperative care mean that more elderly patients can be operated on safely and with a satisfactory outcome. Currently, coronary artery bypass surgery, aortic and mitral valve surgery and surgery of the ascending aorta are performed in elderly patients. Objective: In this review, we summarize the outcome of elderly patients undergoing various cardiac surgical procedures and give future perspectives for the treatment of elderly patients with cardiac surgery. Methods: A PubMed search for the period from 1980 to February 2009 was conducted with the following key words: ‘elderly patient’, ‘cardiac surgery’, ‘CABG aortic surgery’, ‘mitral valve surgery’ and ‘endocarditis’. Additional information concerning population demographics was obtained from the World Health Organization homepage. Results: More and more cardiac surgical procedures are offered to elderly patients. The short- and long-term survival rates of elderly patients are comparable to those of younger patients. Nevertheless, the risk for these patients is only acceptable in the absence of comorbidities. In particular, renal dysfunction, cerebrovascular disease and a poor clinical state are associated with a worse outcome in elderly patients. Conclusion: The data available show that most cardiac surgical procedures can be performed in elderly patients with a satisfactory outcome. Careful patient selection, flawless surgery, meticulous hemostasis, perfect anesthesia and myoacardial protection are basic requirements for the success of cardiac surgery in elderly patients.

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Antegrade Versus Retrograde Cerebral Perfusion in Relation to Postoperative Complications Following Aortic Arch Surgery for Acute Aortic Dissection Type A

Abstract: The antegrade perfusion seems to be related with significantly lower incidence of temporary neurological complications, earlier extubation, shorter ICU-stay, and hospitalization, and hence lower total cost.

Cited by 50 publications

References 37 publications

Recent Advances in the Management of Acute Aortic Syndrome

Recent Advances in the Management of Acute Aortic Syndrome

Typ-A-Dissektion

The Elderly Patient and Cardiac Surgery – A Mini-Review

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