Arch and descending aortic aneurysms: influence of perfusion technique on neurological outcome1

Westaby, Stephen; Katsumata, Takahiro; Vaccari, Giuseppe

doi:10.1016/s1010-7940(98)00310-8

Cited by 79 publications

(41 citation statements)

References 16 publications

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“…To ensure TL perfusion after distal reconstruction, to minimize retrograde delivery of embolic material, and to minimize FL pressurization, there is an overwhelming consensus that orthograde corporeal perfusion via the aortic graft should be instituted if FemA cannulation has previously been used. Femoral cannulation is ill-advised in the presence of distal aortic atherosclerotic disease, because it risks proximal atheroembolization (172,173). In the context of ATAAD, initial FemA cannulation remains reasonable, provided malperfusion monitoring is applied and aortic imaging confirms an absence of atheroma.…”

Section: The Aims and Objectives Of Ataad Surgerymentioning

confidence: 99%

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Bonser

Ranasinghe

Loubani

et al. 2011

Journal of the American College of Cardiology

213

175

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Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection-related complications in the proximal and downstream aorta. No randomized trials of treatment or techniques have ever been performed, and novel therapies-particularly with regard to extent of surgery-are being devised and implemented, but their role needs to be defined. Overall, except in highly specialized centers, surgical outcomes might be static, and there is abundant room for improvement. By highlighting difficulties and controversies in diagnosis, patient selection, and surgical therapy, our over-arching goal should be to enfranchise more patients for treatment and improve surgical outcomes.

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Section: The Aims and Objectives Of Ataad Surgerymentioning

confidence: 99%

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Bonser

Ranasinghe

Loubani

et al. 2011

Journal of the American College of Cardiology

213

175

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“…Profound hypothermic circulatory arrest was the pioneering technique [1] and, later as an adjunct to it, retrograde cerebral perfusion, which is still in use by some have been the preferred procedures for successful aortic arch repair [2]. However, these techniques did not provide necessary safety as far as neurological results are concerned and had some additional deleterious effects due to extended cardiopulmonary bypass times for cooling and rewarming and subsequent disturbances related to deep hypothermia [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Arch repair with unilateral antegrade cerebral perfusion

Küçüker

Özatık

Sarıtaş

et al. 2005

European Journal of Cardio-Thoracic Surgery

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“…Provided that it is safe, ascending aorta cannulation may have a great advantage because of the technical simplicity, especially in the situations of hemodynamic instability. And prompt establishment of antegrade systemic perfusion may also be of benefit [14][15][16]. The obtained results indicated that this technique could be performed safely under ultrasound-guided Seldinger technique.…”

Section: Discussionmentioning

confidence: 99%

Ascending aorta cannulation in acute type A aortic dissection

Inoue¹,

Ueda²,

Taguchi³

et al. 2007

European Journal of Cardio-Thoracic Surgery

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Objective: Antegrade perfusion for type A acute aortic dissection prevents malperfusion and retrograde cerebral embolism during cardiopulmonary bypass. Prompt establishment of antegrade perfusion via ascending aorta may improve the surgical results of type A dissections, especially in the situations of hemodynamic instability. Thus, we evaluated the efficacy of use of the dissected ascending aorta as an alternative arterial inflow. Methods: Between 2002 and 2006, 32 patients underwent prosthetic graft replacement of the ascending aorta or hemiarch for acute type A aortic dissection. The ascending aorta was routinely cannulated, in addition to the femoral artery, with a heparin-coating flexible cannula for arterial inflow, using Seldinger technique, and by epiaortic ultrasonographic guidance (n = 6). Antegrade systemic perfusion via ascending aorta was performed. Results: Ascending aorta cannulation was safely performed in all cases. There was no malperfusion or thromboembolism due to ascending aorta cannulation. Cardiopulmonary bypass was established within 30 min after skin incision. There was one in-hospital death due to duodenal bleeding (1/32 = 3.1%), two cases of cerebral infarction (2/32 = 6.3%), and one case of pulmonary embolism. Twenty-nine patients (29/32 = 90.6%) were discharged in New York Heart Association class I and have been followed up uneventfully for a mean of 17 months. Conclusions: Antegrade perfusion via the ascending aorta was successfully performed with low mortality and morbidity. With ultrasound-guided Seldinger technique, ascending aorta cannulation has a potential to be a simple and safe option that enables rapid establishment of antegrade systemic perfusion in patients with acute type A aortic dissection. #

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Arch and descending aortic aneurysms: influence of perfusion technique on neurological outcome1

Abstract: Anterograde perfusion using a proximal aortic cannula provides a low risk of cerebral embolism and allows extensive aortic resection with low morbidity.

Cited by 79 publications

References 16 publications

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Arch repair with unilateral antegrade cerebral perfusion

Ascending aorta cannulation in acute type A aortic dissection

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