Bilateral versus unilateral antegrade cerebral perfusion in total arch replacement for type A aortic dissection

Tong, Guang; Zhang, Ben; Zhou, Xuan; Tao, Ye; Yan, Tao; Wang, Xianyue; Lu, Hua; Sun, Zhongchan; Zhang, Weida

doi:10.1016/j.jtcvs.2017.02.053

Cited by 45 publications

(52 citation statements)

References 40 publications

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“…In 2017 was published in the Journal of Thoracic and Cardiovascular Surgery the only study comparing unilateral vs. bilateral cerebral perfusion in 203 patients presenting TAAAD (28). There was no significant difference between groups in terms of CPB, cross-clamp and circulatory arrest times.…”

Section: Unilateral Vs Bilateral Cerebral Perfusion Strategymentioning

confidence: 93%

Cerebral perfusion issues in type A aortic dissection

et al. 2018

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Stroke events are very common in acute type A aortic dissection. Cerebral malperfusion could manifest at presentation due to prolonged arch vessels hypoperfusion or develop after surgery for inadequate cerebral protection during arch repair. To reduce this detrimental complication there are several adjuncts that can be adopted for cerebral protection such as direct antegrade or retrograde cerebral perfusion (RCP) and use period of deep to moderate hypothermic circulatory arrest time; however, they are often insufficient as preoperative malperfusion already caused irreversible ischemic damages. The aim of the current review article is to analyze the principal series reporting on neurological injuries during type A aortic dissection to focus on the outcomes according to the type of surgical management and identify possible predictors to better manage this complication.

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Section: Unilateral Vs Bilateral Cerebral Perfusion Strategymentioning

confidence: 93%

Cerebral perfusion issues in type A aortic dissection

et al. 2018

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“…A meta-analysis performed by Malvindi et al, consisting of 17 studies with 2,949 bSACPs and 599 uSACPs, concluded that bSACP allowed for longer SACP time, with increasing safety once the SACP time exceeded 40 to 50 minutes [20]. In a study by Tong et al focusing on the clinical effect of bSACP and uSACP in TAR [21], no signi cant difference was identi ed with regard to 30-day mortality and postoperative PND. The four-branched graft anastomosed to the left carotid artery was used for left hemisphere perfusion, and they concluded that this approach avoided the risk of embolic injury by cannulating the left carotid artery.…”

Section: Discussionmentioning

confidence: 99%

Different hypothermic and cerebral perfusion strategies in extended arch replacement for acute type A aortic dissection: a retrospective comparative study

Dong

Xiong

Zhang

et al. 2020

Preprint

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Background: The optimal hypothermic level in total arch replacement with stented elephant trunk implantation for acute type A aortic dissection (aTAAD) has not been established, and the superiority of unilateral or bilateral cerebral perfusion remains a controversial issue. Therefore, we evaluated the application of moderate hypothermic circulatory arrest (MHCA) with a core temperature of 29℃ and bilateral selective antegrade cerebral perfusion in aTAAD treated by total arch replacement with stented elephant trunk implantation. Methods: From July 2019 to January 2020, 25 aTAAD patients underwent total arch replacement with stented elephant trunk implantation via MHCA (29℃) and bilateral selective antegrade cerebral perfusion (modified group). Thirty-six patients treated by the same procedure with MHCA (25℃) and unilateral selective antegrade cerebral perfusion during this period were selected as controls. Results: There were no differences between the two groups of patients in terms of age, sex, incidence of hypertension, malperfusion, and pericardial effusion, although the incidence of cardiac tamponade was higher in the modified group (control 2.8%, modified 20%; P = 0.038). The lowest mean circulatory arrest temperature was 24.6±0.9℃ in the control group, and 29±0.8℃ in the modified group (P < 0.001). In-hospital mortality was 4.9% (3/61) for the entire cohort (control 8.3%, modified 0; P = 0.262). The incidence of permanent neurologic deficit was 4.9% (control 8.3%, modified 0; P = 0.262). There were no significant differences in the occurrence of temporary neurological deficit, renal failure, and paraplegia between groups. The rate of major adverse events in the modified group was lower (30.6% vs. 4%, P = 0.019). A shorter duration of ventilation and ICU stay was identified in the modified group, as well as a reduced volume of drainage within the first 48 h and red blood cell transfusion.Conclusions: The early results of MHCA (29℃) and bilateral selective antegrade cerebral perfusion applied in total arch replacement with stented elephant trunk implantation for aTAAD were acceptable, providing similar inferior cerebral and visceral protection compared with that of the conventional strategy. A higher core temperature may account for the shorter duration of ventilation and ICU stay, as well as a reduced volume of drainage and red blood cell transfusion.

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“…Maintaining adequate perfusion pressure and flow during EC has protective effects on the brain. 20,21 The MAP should be kept above the preoperative level during the cerebral ischaemia period because an increased MAP can ensure proper perfusion of the ischaemic area by collateral circulation. Mild hypothermia should be induced during EC with systemic cooling and local head cooling because a body temperature of approximately 32 C is recommended to reduce both mortality and the risk of stroke by reducing oxygen demand.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management in endovascular total aortic arch repair via needle-based in situ fenestration: a case series of 14 patients

et al. 2019

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Objective Endovascular total aortic arch repair (ETAAR) via needle-based in situ fenestration (ISF) is a major challenge for anaesthesiologists because of haemodynamic instability and the risk of cerebral hypoxia. We herein summarise our experience with anaesthetic management of patients who underwent this procedure. Methods Fourteen patients who underwent ETAAR via ISF for arch pathologies involving the major supra-arch branches were included. Regional cerebral oxygen saturation was measured to monitor cerebral perfusion. Partial extracorporeal circulation (EC) support from the right common femoral vein to the right axillary artery was introduced to provide cerebral perfusion. Results During ISF, vessel rupture occurred in three patients and ventricular fibrillation occurred in one patient. The regional cerebral oxygen saturation significantly decreased during the potential risk period for cerebral ischaemia. Establishment of EC effectively prevented cerebral ischaemia. Conclusions During ETAAR, the risks of haemodynamic instability caused by the procedure and vessel rupture during ISF need to be overcome. Partial EC ensured good cerebral protection in our study, and regional cerebral oxygen saturation monitoring may help to reduce the rate of desaturation.

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Bilateral versus unilateral antegrade cerebral perfusion in total arch replacement for type A aortic dissection

Cited by 45 publications

References 40 publications

Cerebral perfusion issues in type A aortic dissection

Cerebral perfusion issues in type A aortic dissection

Different hypothermic and cerebral perfusion strategies in extended arch replacement for acute type A aortic dissection: a retrospective comparative study

Anaesthetic management in endovascular total aortic arch repair via needle-based in situ fenestration: a case series of 14 patients

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