Brain protection using antegrade selective cerebral perfusion: a multicenter study

Eusanio, Marco Di; Schepens, Marc A.A.M.; Morshuis, Wim J.; Dossche, Karl M.; Bartolomeo, Roberto Di; Pacini, Davide; Pierangeli, A; Kazui, Teruhisa; Ohkura, Kazuhiro; Washiyama, Naoki

doi:10.1016/s0003-4975(03)00824-5

Cited by 157 publications

(88 citation statements)

References 19 publications

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“…In the subgroup of patients with diagnosis of aortic dissection, EM was 26%, and PND were 18%, in line with other report in literature. 2,[7][8][9][10][11] The finding that aortic dissection was a risk factor for both mortality, PND and NE was not unexpected, and it is in accord with the observations of others. 8,9,[12][13][14] An important result of this study was that in the follow-up neurocognitive analysis did not show worse postoperative impairment in cognitive, psychological and neurological functions in the case of dissection compared to non-dissection.…”

Section: Discussionsupporting

confidence: 90%

Neurologic and cognitive outcomes after aortic arch operation with hypothermic circulatory arrest

Centofanti

Barbero

D’Agata

et al. 2016

Surgery

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Section: Discussionsupporting

confidence: 90%

Neurologic and cognitive outcomes after aortic arch operation with hypothermic circulatory arrest

Centofanti

Barbero

D’Agata

et al. 2016

Surgery

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“…(2,5,14) Çok merkezli başka bir çalışma-da aortik ark rekonstrüksiyonu yapılan 588 hastada DHSA ve SASP uygulanmış ve GND insidansı % 5,1 olarak bildirilmiştir. (8) Svensson ve ark. (20) asendan aorta, femo-ral ve aksiller kanülasyon yerlerini karşı-laştırdıkları çalışmalarında sağ aksiller arterin kanülasyon için kullanılması ile KND insidansının en az olduğu bildirilmiştir.…”

Section: Discussionunclassified

“…(6,8,10) Arkus aorta cerrahisinde mediyan sternotomi uygulandı. Sistemik heparinizasyon intravenöz heparin 300 Ü kg -1 doz ile sağlandı.…”

Section: Operasyonda Kardiyopulmoner Baypas Yönetimiunclassified

“…(5,6) Mortalite insidansı cerrahi patoloji ve birlikte görülen kardiyovasküler ve diğer hastalıklara göre % 6 ile % 23 arasında değişkenlik göster-mektedir. (6)(7)(8) Bu çalışmada amacımız, aort anevrizma onarım operasyonlarında farklı cerrahi kanülasyon teknikleri, ısı regü-lasyonu ve beyin koruma yöntemlerinin perioperatif dönemde mortalite ile ilişkili çeşitli risk faktörlerine etkilerinin incelenmesidir.…”

Section: Introductionunclassified

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The Effects of Different Methods Applied for the Protection of Myocardial and Brain Functions During Aortic Aneurysm Repair Surgery on the Prognosis and Survival

Baysal¹,

Doğukan²,

Temel³

et al. 2012

JTAICS

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ÖZETAmaç: Aort anevrizma onarım operasyonlarında farklı cerrahi kanülasyon teknikleri, ısı regülasyonu ve beyin koruma yöntemlerinin mortalite üzerinde etkili perioperatif risk faktörleri ile ilişkisinin incelenmesini amaçladık. Bu nedenle; derin hipotermik sirkulatuar arrest (DHSA) ve retrograd serebral perfüzyon (RSP) altında femoral veya aortik kanülasyon ile uygulanan hastalar, orta derecede hipotermik sirkulatuar arrest (OHSA) ve selektif antegrad serebral perfüzyon (SASP) altında aksiller kanülasyon uygulanan hastalar karşılaştırıldı.Gereç ve Yöntem: Aortik ark anevrizma onarım operasyonu olan 110 ardışık hasta prospektif nonrandomize bir çalışma planı içeri-sinde üç ayrı gruba cerrahi patoloji, operasyon ve anestezi tekniklerine dayanılarak ayrıldı. Grup 1'de; femoral kanülasyon, DHSA (22-25°C), ve RSP uygulanırken, Grup 2'de; aksiller kanülasyon, OHSA ve SASP, Grup 3'te; aortik kanülasyon, DHSA ve RSP uygulandı. Perioperatif risk faktörleri araştırıldı.Bulgular: Üç grup karşılaştırıldığında kros klamp ve kardiyopulmoner baypas (KPB) süreleri (dk.) farklı idi (Grup 1'de; 75,62±26,28 ve144,15±66,71, Grup 2'de; 60,57±26,32 ve 109,09±45,38, Grup 3'te; 72,90±23,33 ve 120,83±53,46 sırası ile p=0,021). Mortalite hızlarının karşılaştırması; Grup 1'de 10/34 (% 29,4), Grup 2'de 3/47 (% 6,4) ve Grup 3'te 3/29 (% 10,3) (p=0,011) hasta olduğunu gösterdi. IABP kullanımı, kalp yetmezliği, atrial ritim bozukluklarının mortalite için bağımsız risk faktörleri olduğu saptandı (% 95 gü-ven aralığında; Hosmer and Lemeshow testi, ki kare=5,71 ve p=0,68).Sonuç: OHSA, SASP ve aksiller kanülasyon ile aortik ark anevrizma onarımı geçiren hastalarda morbidite ve mortalite DHSA, RSP ve femoral veya aortik kanülasyon yapılan hastalar ile karşılaştırıldığında daha az oranda gözlenmektedir.Anahtar kelimeler: Aortik anevrizma, derin hipotermik sirkülatuar arrest, orta derecede hipotermik sirkulatuar arrest SUMMARY The Effects of Different Methods Applied for the Protection of Myocardial and Brain Functions During Aortic Aneurysm Repair Surgery on the Prognosis and SurvivalObjective: Our aim was to investigate the relation between perioperative risk factors influencing mortality and different methods of surgical cannulation, temperature regulation and cerebral protection in patients undergoing aortic aneurysm repair surgery. For this purpose; patients requiring deep hypothermic circulatory arrest (DHCA), retrograde cerebral perfusion (RCP) and femoral or aortic cannulation were compared with patients requiring axillary cannulation, moderate hypothermic circulatory arrest (MHCA) and selective antegrade cerebral perfusion (SACP).Material and Methods: 110 consecutive patients undergoing aortic arch aneurysm repair surgery were divided into three groups in a prospective, nonrandomized study plan depending on surgical pathology, operation and anesthesia techniques. In Group 1, femoral cannulation, DHCA (22-25°C) and RSP ; in Group 2, axillary cannulation, MHCA (26-28°C) and SACP, whereas, in Group 3, aortic cannulation, DHCA and RCP were per...

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“…However, more recently, femoral artery cannulation is reserved for complicated cases when aortic cannulation is deemed challenging, such as in aortic dissection or chronic proximal aortic and arch aneurysms. The decreasing reliance on routine femoral artery cannulation is secondary to the perceived increased risk of retrograde cerebral embolization, organ malperfusion, perfusion of the false lumen and retrograde dissection due to flow reversal in the thoracoabdominal aorta (1). There has been a simultaneous increase in published reports of CC with axillary artery cannulation emerging as the favoured strategy due to it being a safe and easy technique, especially in patients with a diseased ascending aorta or when femoral artery cannulation is precluded such as in the presence of aortoiliac aneurysms, severe peripheral occlusive disease, atherosclerosis of the femoral vessels, and distal extension of the aortic dissection (2).…”

mentioning

confidence: 99%

Cannulation strategies for aortic surgery: which is the best one?

Raja

2017

J. Thorac. Dis.

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The choice of the optimal arterial cannulation strategy for surgery on proximal aorta and arch remains a controversial area and a subject of intense debate. The search for the best cannulation strategy for aortic surgery assumes increasing importance due to its impact on clinical outcomes. Several cannulation strategies have been proposed to establish cardiopulmonary bypass (CPB) for aortic surgery and each one of these has its pros and cons. These cannulation strategies can be broadly classified into central and peripheral cannulation strategies. Sites of central cannulation (CC) include the ascending aorta itself as well as the innominate, subclavian and axillary artery whereas femoral artery cannulation is synonymous with peripheral cannulation (PC).Traditionally, the femoral artery has been the preferred arterial cannulation site for establishing CPB for proximal aortic and arch surgery. However, more recently, femoral artery cannulation is reserved for complicated cases when aortic cannulation is deemed challenging, such as in aortic dissection or chronic proximal aortic and arch aneurysms. The decreasing reliance on routine femoral artery cannulation is secondary to the perceived increased risk of retrograde cerebral embolization, organ malperfusion, perfusion of the false lumen and retrograde dissection due to flow reversal in the thoracoabdominal aorta (1). There has been a simultaneous increase in published reports of CC with axillary artery cannulation emerging as the favoured strategy due to it being a safe and easy technique, especially in patients with a diseased ascending aorta or when femoral artery cannulation is precluded such as in the presence of aortoiliac aneurysms, severe peripheral occlusive disease, atherosclerosis of the femoral vessels, and distal extension of the aortic dissection (2).In the current era of evidence-based medicine, it is vital that strategies that are backed by current best available evidence are adopted to ensure that clinical outcomes for complex procedures such proximal aortic and arch surgery are further improved. Interestingly, there is a lack of gold standard evidence from randomized controlled trials comparing CC and PC. Majority of the evidence on the subject is in the form of observational cohort studies of variable reporting quality and conflicting results (3,4). Our group attempted to provide some clarity on the subject by undertaking a meta-analysis of comparative studies reporting operative outcomes following CC and PC (5). This meta-analysis included a total of 4,476 patients. CC was used in 2,797 cases and PC in 1,679 cases. CC showed a protective effect on in-hospital mortality (RR 0.59; 95% CI, 0.48-0.7; P<0.001) and permanent neurologic deficit (RR 0.71; 95% CI, P=0.005) when compared to PC. A trend towards an increased benefit in terms of reduced in-hospital mortality was observed when the right axillary artery only was used as CC approach (RR 0.35; 95% CI, 0.22-0.55; P<0.001; I 2 =0%) (5). This trend seems to be attributed to antegrade cerebral perfu...

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Brain protection using antegrade selective cerebral perfusion: a multicenter study

Cited by 157 publications

References 19 publications

Neurologic and cognitive outcomes after aortic arch operation with hypothermic circulatory arrest

Neurologic and cognitive outcomes after aortic arch operation with hypothermic circulatory arrest

The Effects of Different Methods Applied for the Protection of Myocardial and Brain Functions During Aortic Aneurysm Repair Surgery on the Prognosis and Survival

Cannulation strategies for aortic surgery: which is the best one?

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