Aortic Arch Surgery With a Single Centrifugal Pump for Selective Cerebral Perfusion and Systemic Circulation

Iwata, Keiji; Shimazaki, Yasuhisa; Sakamoto, Tomohiko; Ueda, Hiroyuki; Nakagawa, Masashi; Yamada, Hideto; Doi, Teruo; Ooue, Takuya

doi:10.1111/j.1525-1594.2009.00892.x

Cited by 3 publications

(5 citation statements)

References 9 publications

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“…In contrast to other perfusion strategies, using a single centrifugal pump and a dividing arterial line (11) or two roller pumps (10), we can regulate and control pump flow independently of each other. Also, using dividing arterial lines and adjustment of flows using flow restricting devices may induce hemolysis.…”

Section: Results Of Aortic Arch Replacement Surgery Have Improved Ove...mentioning

confidence: 99%

“…Surgical techniques and results after aortic arch replacement procedures have been well described (7)(8)(9). However, although their careful selection is crucial to the success of treatment, the cannulation and perfusion strategies used are specified in only a few publications (10,11). Furthermore, when considering the negative impact of circulatory arrest, one should focus on its effects on both the spinal cord and postoperative endorgan function (12).…”

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confidence: 99%

“…We hypothesize that the simultaneous selective perfusion of lower body, heart, and brain shortens organ ischemia time during aortic arch surgery and thus also helps preserving postoperative end-organ function. The use of one pump and branching of the arterial line for uncontrolled simultaneous perfusion of body and brain has been described (11). However, this perfusion strategy might be inadequate.…”

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confidence: 99%

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Selective Heart, Brain and Body Perfusion in Open Aortic Arch Replacement

Maier

Kari

Rylski

et al. 2016

J Extra Corpor Technol

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Open aortic arch replacement is a complex and challenging procedure, especially in post dissection aneurysms and in redo procedures after previous surgery of the ascending aorta or aortic root. We report our experience with the simultaneous selective perfusion of heart, brain, and remaining body to ensure optimal perfusion and to minimize perfusion-related risks during these procedures. We used a specially configured heart–lung machine with a centrifugal pump as arterial pump and an additional roller pump for the selective cerebral perfusion. Initial arterial cannulation is achieved via femoral artery or right axillary artery. After lower body circulatory arrest and selective antegrade cerebral perfusion for the distal arch anastomosis, we started selective lower body perfusion simultaneously to the selective antegrade cerebral perfusion and heart perfusion. Eighteen patients were successfully treated with this perfusion strategy from October 2012 to November 2015. No complications related to the heart–lung machine and the cannulation occurred during the procedures. Mean cardiopulmonary bypass time was 239 ± 33 minutes, the simultaneous selective perfusion of brain, heart, and remaining body lasted 55 ± 23 minutes. One patient suffered temporary neurological deficit that resolved completely during intensive care unit stay. No patient experienced a permanent neurological deficit or end-organ dysfunction. These high-risk procedures require a concept with a special setup of the heart–lung machine. Our perfusion strategy for aortic arch replacement ensures a selective perfusion of heart, brain, and lower body during this complex procedure and we observed excellent outcomes in this small series. This perfusion strategy is also applicable for redo procedures.

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Section: Results Of Aortic Arch Replacement Surgery Have Improved Ove...mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Selective Heart, Brain and Body Perfusion in Open Aortic Arch Replacement

Maier

Kari

Rylski

et al. 2016

J Extra Corpor Technol

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“…Keiji Iwata et al. (25) of the Social Insurance Kinan Hospital‐Cardiovascular Surgery, Shinjo‐cho Tanabe, Wakayama, Japan evaluated a new technique with a single centrifugal pump for systemic perfusion and selective cerebral perfusion (SCP) and its efficacy and safety. This technique was adopted for total arch replacement in 22 consecutive patients with true aneurysms (13) and aortic dissection (nine).…”

Section: Cardiac Support and Blood Pumpsmentioning

confidence: 99%

Artificial Organs 2010: A Year in Review

Malchesky¹

2011

Artificial Organs

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In this Editor's Review, articles published in 2010 are organized by category and briefly summarized. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, and the International Society for Rotary Blood Pumps, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level."Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide such meaningful suggestions to the author's work whether eventually accepted or rejected and especially to those whose native tongue is not English. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, Wiley-Blackwell, for their expert attention and support in the production and marketing of Artificial Organs. In this Editor's Review, that historically has been widely received by our readership, we aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. We look forward to recording further advances in the coming years.

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“…Dr. Iwata and colleagues recently reported a case series using a single centrifugal pump and four separate arterial lines for antegrade selective cerebral perfusion (ASCP) and systemic circulation for aortic arch construction (1). They should be congratulated for excellent clinical results and rational perfusion design for ASCP during deep hyperthermia circulatory arrest (DHCA).…”

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confidence: 99%

Optimal Strategy of Selective Cerebral Perfusion During Aortic Arch Construction

Liu

Hei

et al. 2010

Artificial Organs

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Dr. Iwata and colleagues recently reported a case series using a single centrifugal pump and four separate arterial lines for antegrade selective cerebral perfusion (ASCP) and systemic circulation for aortic arch construction (1). They should be congratulated for excellent clinical results and rational perfusion design for ASCP during deep hyperthermia circulatory arrest (DHCA).Currently, DHCA with ASCP is widely accepted as a routine means to protect the central nervous system during aortic arch reconstruction; however, the risks of central neurologic complications related to DHCA and extensive ASCP times also remain a substantial burden in aortic arch construction. As a result, the best way to protect the brain, spinal cord, and major organs is to shorten the period of ASCP as much as possible to avoid malperfusion during DHCA. ASCP has become recognized as an important way for arch replacement and can be performed through several different means: right axillary artery cannulation with balloon catheter in the left common carotid artery (2), direct balloon catheter perfusion of the innominate and left common carotid arteries (3-7), unilateral cerebral perfusion through the right axillary artery (8) or the right brachial artery (9), and even direct, bilateral cannulation of the carotid arteries outside the thorax (10).In this particular investigation, the authors used one centrifugal pump and four separate arterial lines for ASCP and system perfusion with four different cannular sites. We would like to compare their ASCP method with ours (one pump with two separate arterial lines), and discuss possible optimal ASCP strategy during aortic arch surgery. First, the authors maintained ASCP flow rate with 10 mL/ min/kg to perfuse the brain bilaterally via three cannulae using the brachiocephalic artery, left common carotid artery, and left subclavian artery, respectively. Compared with bilateral cerebral perfusion (BCP), unilateral cerebral perfusion (UCP) through the axillary or right subclavian artery has been used in our hospital since 1996; we have used BCP only for patients suspected of having a nonintegrated circle of Willis (11). Although the authors' method in this study using three perfusion cannulae in the limited space of the mediastinum may obscure the operative field during arch replacement, the distribution of blood flow for the brain is more physiological. In our current study (unpublished data), we did not find any difference in the distribution of blood flow between UCP and BCP under DHCA using a transcranial Doppler for patients with an integrated circle of Willis during aortic arch reconstruction and stented elephant trunk procedure; however, malperfusion was observed once the system perfusion was initiated via one graft of the four-branched graft, and overperfusion was found in the brain using a transcranial Doppler with UCP. In their article, the authors also measured the flows with an ultrasound flow meter, and after recovering the full system flow, and there was no malperfusion observed. A possi...

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Aortic Arch Surgery With a Single Centrifugal Pump for Selective Cerebral Perfusion and Systemic Circulation

Cited by 3 publications

References 9 publications

Selective Heart, Brain and Body Perfusion in Open Aortic Arch Replacement

Selective Heart, Brain and Body Perfusion in Open Aortic Arch Replacement

Artificial Organs 2010: A Year in Review

Optimal Strategy of Selective Cerebral Perfusion During Aortic Arch Construction

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