Comparative experimental study of cerebral protection during aortic arch reconstruction

Sakurada, T; Kazui, Teruhisa; Tanaka, Hisashi; Komatsu, S

doi:10.1016/0003-4975(96)00026-4

Cited by 73 publications

(32 citation statements)

References 13 publications

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“…49 , tem as vantagens de proporcionar um resfriamento cerebral sustentado, lavar metabólitos resultantes da isquemia, retirar o ar ou mesmo debris com potencial emboligênico, e permitir a infusão de substratos nutricionais durante a PCC. Entretanto, potenciais limitações como distribuição intracerebral não homogênea, presença de válvulas no sistema jugular 50 , edema cerebral 51 , fluxo cerebral insuficiente 52 , e sangramento no campo operatório, têm tornado seu emprego discutível.…”

Section: Dissecções Agudas Da Aortaunclassified

“…Entre 1984 e 1998, os autores utilizaram PCC e cerebroplegia em 171 casos de substituição do arco aórtico, 42 dos quais devido a dissecções tipo A; o tempo médio de CEC foi de 121min, o tempo médio de perfusão cerebral seletiva 60min, a mortalidade hospitalar 17%, e a ocorrência de dano neurológico pós-operatório 13% 56 . Embora outros estudos também sugiram superioridade da perfusão anterógrada sobre a RPC e a PCC hipotérmica, tanto em nível clínico 51,57 como experimental 52 , complicações como sangramento nos sítios de canulação e hemorragia intracerebral têm restringido seu uso a poucos centros.…”

Section: Dissecções Agudas Da Aortaunclassified

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Diretrizes para a cirurgia das doenças da aorta

Albuquerque¹,

Palma²,

Braile³

et al. 2004

Arq. Bras. Cardiol.

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Section: Dissecções Agudas Da Aortaunclassified

Diretrizes para a cirurgia das doenças da aorta

Albuquerque¹,

Palma²,

Braile³

et al. 2004

Arq. Bras. Cardiol.

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“…[4][5][6][7] For more complex arch repairs or extensive aortic arch disease, superior cerebral protective technique is of crucial importance. Recently, success in performing this surgery in Japan, puts the technique in the top of its class worldwide.…”

mentioning

confidence: 99%

Factors Influencing Permanent Neurologic Dysfunction and Mortality after Total Arch Replacement with Separate Arch Vessel Grafting Using Selective Cerebral Perfusion

Nakamura

Yano

et al. 2011

ATCS

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Objectives: The present study was undertaken to identify risk factors for permanent neurological dysfunction (PND) and in-hospital mortality after total aortic arch replacement (TAR) with separate arch vessel grafting using selective cerebral perfusion (SCP) and hypothermic circulatory arrest. Methods: Between 1998 and 2008, we preformed a TAR on 143 consecutive patients in two centers by identical methods. Of these, 19 (13.3%) were emergency operations, and 46 (32.2%) were open stent-graft placements. Statistical analysis was performed to determine risk factors for PND and mortality, and furthermore, the survival rate was analyzed. Results: The in-hospital mortality rate was 4.9%, with chronic renal failure (p = 0.0013, odds ratio 10.0) as a significant risk factor. Nine patients (6.3%) had PND, with significant risk factors identified as (1) the presence of an old cerebral or silent lacunar infarction on preoperative imaging methods ( p = 0.0458, odds ratio 8.0) and (2) duration of SCP ( p = 0.0026, odds ratio 1.036). Long-term survival was the same in patients with or without PND. Conclusion: The enhanced vulnerability of the brain in patients with a pre-existing old cerebral infarction or silent lacunar infarction is reflected by a high incidence of PND. Chronic renal failure had an impact on in-hospital mortality.

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“…По мере снижения летальности в этой группе пациентов обнажилась потенциальная угроза развития неврологических осложнений, связанных с применени-ем метода ГЦА. С внедрением в практику метода СЦП было описано снижение частоты возникновения невро-логических осложнений в сравнении с методом ГЦА как в клинической практике [1][2][3], так и в эксперименте [4,5]. Интерес к методу СЦП возрос с появлением ряда публикаций, посвященных совершенствованию техники СЦП при реконструкции аорты, что позволило снизить длительность ГЦА или же полностью исключить его [6][7][8][9][10][11].…”

Section: Discussionunclassified

“…табл. 4), не является показательной, хотя может трактоваться как недостаток метода ГЦА, который обусловливает развитие выраженного отечного синдрома вследствие повреждения клеточных мембран в период от-сутствия кровообращения [5].…”

Section: Discussionunclassified