Aortic Arch Replacement Using Selective Cerebral Perfusion

Kazui, Teruhisa; Yamashita, Katsushi; Washiyama, Naoki; Terada, Hitoshi; Bashar, Abul Hasan Muhammad; Suzuki, Kazunao; Suzuki, Takahiro

doi:10.1016/j.athoracsur.2006.10.082

Cited by 146 publications

(116 citation statements)

References 5 publications

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“…Mortality rates from the world's leading hospitals for patients undergoing aortic arch replacement have been between 4% and 7%. 9,[11][12][13] On the other hand, results from standard hospitals were not as good as from these leading hospitals. For example, the UK Cardiac Surgical Register in 2000 reported that the mortality rate for the aortic arch procedure was 28%.…”

Section: Discussionmentioning

confidence: 83%

“…These parameters were almost the same as those reported in the previous studies from several major centers. 8,11 Through this risk model, we have constructed our own calculator for the expected mortality from thoracic aortic surgery, similar to the EuroSCORE or STS National Database Calculator. We feel certain that the employment of this calculator will contribute to improvement in the quality control of daily practice in the field of thoracic aortic surgery.…”

Section: Discussionmentioning

confidence: 99%

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Risk Model of Thoracic Aortic Surgery in 4707 Cases From a Nationwide Single-Race Population Through a Web-Based Data Entry System

et al. 2008

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Background-The objective of this study was to collect integrated data from nationwide hospitals using a web-based national database system to build up our own risk model for the outcome from thoracic aortic surgery. Methods and Results-The Japan Adult Cardiovascular Surgery Database was used; this involved approximately 180 hospitals throughout Japan through a web-based data entry system. Variables and definitions are almost identical to the STS National Database. After data cleanup, 4707 records were analyzed from 97 hospitals (between January 1, 2000, and December 31, 2005). Mean age was 66.5 years. Preoperatively, the incidence of chronic lung disease was 11%, renal failure was 9%, and rupture or malperfusion was 10%. The incidence of the location along the aorta requiring replacement surgery (including overlapping areas) was: aortic root, 10%; ascending aorta, 47%; aortic arch, 44%; distal arch, 21%; descending aorta, 27%; and thoracoabdominal aorta, 8%. Raw 30-day and 30-day operative mortality rates were 6.7% and 8.6%, respectively. Postoperative incidence of permanent stroke was 6.1%, and renal failure requiring dialysis was 6.7%. OR for 30-day operative mortality was as follows: emergency or salvage, 3.7; creatinine Ͼ3.0 mg/dL, 3.0; and unexpected coronary artery bypass graft, 2.6. As a performance metric of the risk model, C-index of 30-day and 30-day operative mortality was 0.79 and 0.78, respectively. Conclusion-This is the first report of risk stratification on thoracic aortic surgery using a nationwide surgical database.Although condition of these patients undergoing thoracic aortic surgery was much more serious than other procedures, the result of this series was excellent. (Circulation. 2008;118[suppl 1]:S153-S159.)

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Risk Model of Thoracic Aortic Surgery in 4707 Cases From a Nationwide Single-Race Population Through a Web-Based Data Entry System

et al. 2008

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“…There were some major, independent risk factors reported for PND after the aortic arch operation per- 12,17) history of cerebrovascular accident, 8,9,12,17) male, 8) and older age (>60 years).…”

Section: Discussionmentioning

confidence: 99%

“…SCP prevents ischemic damage to the brain during circulatory arrest, so it facilitates complicated aortic arch replacement, resulting in a significant reduction of mortality and morbidity for aortic arch repair. [7][8][9][10][11][12] However, it has some disadvantages including greater complexity, a cumbersome operative field, and an inherent risk for cerebral embolism an inherent risk for cerebral embolism caused by insertion of perfusion cannula for SCP. In this study, we retrospectively examined factors that influence postoperative PND and in-hospital mortality after TAR surgery preformed with separate arch vessel grafting during SCP.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Permanent Neurologic Dysfunction and Mortality after Total Arch Replacement with Separate Arch Vessel Grafting Using Selective Cerebral Perfusion

Nakamura

Yano

et al. 2011

ATCS

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Objectives: The present study was undertaken to identify risk factors for permanent neurological dysfunction (PND) and in-hospital mortality after total aortic arch replacement (TAR) with separate arch vessel grafting using selective cerebral perfusion (SCP) and hypothermic circulatory arrest. Methods: Between 1998 and 2008, we preformed a TAR on 143 consecutive patients in two centers by identical methods. Of these, 19 (13.3%) were emergency operations, and 46 (32.2%) were open stent-graft placements. Statistical analysis was performed to determine risk factors for PND and mortality, and furthermore, the survival rate was analyzed. Results: The in-hospital mortality rate was 4.9%, with chronic renal failure (p = 0.0013, odds ratio 10.0) as a significant risk factor. Nine patients (6.3%) had PND, with significant risk factors identified as (1) the presence of an old cerebral or silent lacunar infarction on preoperative imaging methods ( p = 0.0458, odds ratio 8.0) and (2) duration of SCP ( p = 0.0026, odds ratio 1.036). Long-term survival was the same in patients with or without PND. Conclusion: The enhanced vulnerability of the brain in patients with a pre-existing old cerebral infarction or silent lacunar infarction is reflected by a high incidence of PND. Chronic renal failure had an impact on in-hospital mortality.

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“…(2)(3)(4)(5) In this article, we present our successful emergency surgical therapeutic approach in a female case with a ruptured giant aortic arch aneurysm.…”

Section: Introductionmentioning

confidence: 99%

Successful surgical treatment of a ruptured giant atherosclerotic aneurysm of arcus aorta

Akça¹,

Erdil²,

Disli³

2017

ejcm

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Endovascular aortic repairs in hybrid theatres have been implemented as an alternative option for the treatment of aortic arch aneurysms. The improvements in synthetic graft technologies, cardiopulmonary bypass techniques, blood protection, myocardial protection and protection of the central nervous system have resulted in safer applications of surgical interventions, particularly to the arcus aorta. In this article, we present our successful emergency surgical therapeutic approach in a 74-year-old female patient case with a ruptured giant aortic arch aneurysm.Key words: Endovascular aortic repairs, aortic arch aneurysms, arcus aorta. Abstract

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Aortic Arch Replacement Using Selective Cerebral Perfusion

Cited by 146 publications

References 5 publications

Risk Model of Thoracic Aortic Surgery in 4707 Cases From a Nationwide Single-Race Population Through a Web-Based Data Entry System

Risk Model of Thoracic Aortic Surgery in 4707 Cases From a Nationwide Single-Race Population Through a Web-Based Data Entry System

Factors Influencing Permanent Neurologic Dysfunction and Mortality after Total Arch Replacement with Separate Arch Vessel Grafting Using Selective Cerebral Perfusion

Successful surgical treatment of a ruptured giant atherosclerotic aneurysm of arcus aorta

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