Cerebral malperfusion in acute type A dissection: Direct innominate artery cannulation

Abstract

with a liposarcoma are symptomatic and that 15% have an asymptomatic liposarcoma discovered on a routine chest radiograph. Liposarcomas are usually large. The cases reported by Klimstra and associates 3 ranged from 6 to 40 cm, with a mean weight of 1500 g. Enzinger and Weiss 4 divided liposarcomas into the following 5 major morphologic subtypes: well differentiated, myxoid, round cell, dedifferentiated, and pleomorphic. Myxoid liposarcomas account for 40% to 50% of these tumors. Welldifferentiated liposarcomas are a less-aggressive neoplasm and can produce metastases. Complete surgical excision is the preferred therapeutic choice. Recurrence can occur in a subtotal resection despite adjuvant therapy. The pseudoencapsulated lesions that can be completely removed have a better prognosis than the noncapsulated and less well-differentiated tumors; however, most primary chest wall soft tissue sarcomas (70%) are low grade. Local recurrence was reported in 33% of patients in the study by Greager and colleagues. 5 The presence of local recurrence has no significant effect on the overall survival. 1 Radiotherapy may be effective in the control of local recurrence, but its role is unclear.

Near-infrared spectroscopy as an index of brain and tissue oxygenation

“…It was concluded that monitoring of regional cerebral tissue oxygen saturation using NIRS during SACP allows detection of clinically important cerebral desaturations and can help predict perioperative neurological sequelae. 59 There have also been a number of case reports of aortic arch surgery in which cerebral oximetry has been shown to detect cerebral hypoperfusion from a variety of factors including ascending aortic dissection with occlusion of carotid lumen, 33 intraoperative thrombosis of a common carotid graft, 69 kinking or obstruction of perfusion cannula during SACP, 67 or due to diminished Blalock -Taussig shunt flow after paediatric cardiac surgery. 65…”

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

“…In small series, combined RAxA/ScA and FemA cannulation have been used to prevent malperfusion with encouraging outcomes (194). Carotid and innominate artery cannulation to avoid malperfusion have also been used by some authors (195)(196)(197)198), and occasionally unique perfusion solutions have been generated to combat intraoperative malperfusion (199).…”

Feasibility of cerebral near‐infrared spectroscopy monitoring in the pre‐hospital environment

“…Tissue oximetry may provide information regarding oxygenation from potentially ischaemic tissues. Its clinical utility has already been demonstrated in a wide variety of clinical settings including monitoring of tissue flaps after surgery, detecting cerebral vasospasm, cerebral monitoring intraoperatively for cardiac surgery and in detecting silent cerebral ischaemia in a number of different settings . There is a growing body of research exploring the utility of NIRS cerebral oximetry in the monitoring of neurotrauma patients, incorporating not just oximetry values, but also indices derived from total haemoglobin measurements and NIRS‐derived values relying on the absorption of light by cytochromes to provide information regarding the mitochondrial redox state of monitored tissues …”