Continuous Cerebral Perfusion for Aortic Arch Repair: Hypothermia Versus Normothermia

Ly, Mohamed; Roubertie, François; Belli, Emrè; Grollmuss, Oswin; Bui, Minh Thanh; Roussin, Régine; Lebret, Emmanuel; Capderou, André; Sérraf, Alain

doi:10.1016/j.athoracsur.2011.03.006

Cited by 31 publications

(30 citation statements)

References 21 publications

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“…Of the remained 3032 studies were selected by review of title and abstract, 148 studies were retrieved for full text review. Finally, seven RCTs were included according to our prespecified inclusion criteria, enrolling 419 pediatric patients undergoing cardiac surgery from seven countries (Figure ). Study methodological quality is listed (Table ).…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta‐Analysis of benefits and risks between normothermia and hypothermia during cardiopulmonary bypass in pediatric cardiac surgery

Xiong

Sun

et al. 2014

Pediatric Anesthesia

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Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta‐Analysis of benefits and risks between normothermia and hypothermia during cardiopulmonary bypass in pediatric cardiac surgery

Xiong

Sun

et al. 2014

Pediatric Anesthesia

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“…Even so, the optimal perfusion strategy for one‐stage aortic arch surgeries remains inconclusive. Previous studies have confirmed the safety and feasibility of both SRCP and CMP, respectively. The purpose of this study was to compare the merits and drawbacks of the two perfusion methods from the aspect of perioperative blood products transfusion.…”

Section: Discussionmentioning

confidence: 73%

“…In recent years, lower body circulatory arrest combined with regional cerebral perfusion (RCP) has become the first choice for aortic arch surgeries in most cardiac centers, as it can meet the clinical requirements of one‐stage aortic arch repairs. With the progress of surgical techniques, some perfusionists have gradually increased the perfusion temperature during RCP, thus shortening the cardiopulmonary bypass time significantly. Compared with systemic DHCA strategy in the past, the incidence of hypothermia‐related coagulation diseases, renal dysfunctions, nervous system impairments, and the recurrent occlusion after neonatal aortic arch operations were dramatically decreased.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with systemic DHCA strategy in the past, the incidence of hypothermia‐related coagulation diseases, renal dysfunctions, nervous system impairments, and the recurrent occlusion after neonatal aortic arch operations were dramatically decreased. Prognosis of neonates improved significantly . CMP provides non‐working heartbeats at low temperature by simultaneous perfusion of cerebral vessels and coronary arteries during operations, which observably shortens the duration of cardioplegia, CPB and temperature change.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative blood product transfusion of two different perfusion strategies on pediatric patients undergoing aortic arch surgery

Tong

Zhang

et al. 2019

Artificial Organs

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Simple regional cerebral perfusion (SRCP) or cerebro‐myocardial perfusion (CMP) is selectively used in one‐stage complex aortic arch malformation repair. This analysis was performed to investigate the effect of CMP and SRCP on perioperative blood product consumption, and to evaluate whether these two strategies have different effects on the clinical outcomes. A retrospective analysis of 284 children with complicated aortic malformation from January 2010 to June 2018 was performed. The overall cohort was divided into SRCP group (n = 202) and CMP group (n = 82). A comprehensive comparison of perioperative blood product consumption‐related indexes was performed. Cardiopulmonary bypass time, cardiac arrest time, cooling, and rewarming time in the CMP group were significantly shorter than those in the SRCP group (P < .05). Chest tube time was 3.82 ± 1.33 days in the SRCP group compared to 3.42 ± 0.97 days in the CMP group (P = .005). Moreover, intraoperative platelet (PLT) transfusion volume (mL/kg) and rate (%) were significantly lower in the CMP group (P < .001). Multivariate regression analysis found that intraoperative PLT transfusion was significantly negatively correlated with CMP management [OR = 0.237 (0.110‐0.507), P < .001] and CPB time was independently associated with delayed chest tube removal (>3 days) [OR = 1.010 (1.001‐1.020), P = .031]. In‐hospital mortality and early postoperative adverse events were not significantly different between the two groups. In children with on‐pump complex aortic arch surgeries, CMP is more preferable than SRCP in blood protection. However, overall prognosis was not remarkably different between these two perfusion groups. They are both safe and feasible.

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“…Most surgeons use deep hypothermia, down to temperatures of 18°C, or between 20 and 25°C. However, SCAP at 29‐31°C or above 34°C has been reported with no neurologic complications.…”

Section: Hypothermiamentioning

confidence: 98%

Recent achievements and future developments in neonatal cardiopulmonary bypass

Bojan

2019

Pediatric Anesthesia

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Summary A primary goal of improving neonatal cardiopulmonary bypass has been making the circuit smaller and reduce the blood contacting surfaces. As bypass circuit size has decreased, bloodless surgery has become possible even in neonates. Since transfusion guidelines are difficult to construct based on existing literature, these technical advances should be taken advantage of in conjunction with an individualized transfusion scheme, based on monitoring of oxygen availability to the tissues. For the majority of neonatal heart operations, several centers have shifted toward normothermic bypass even for complex neonatal surgeries, in order to avoid the adverse effects of hypothermia. Deep hypothermic circulatory arrest is no longer a necessity but an option, and selective antegrade cerebral perfusion has become common practice; however, technical uncertainties with regard to this technique have to be addressed, based on reliable neurologic monitoring. Maintenance of patient‐specific heparin concentrations during bypass is another key goal, since neonates have lower baseline antithrombin concentrations and, therefore, a higher risk for inadequate thrombin inhibition and postoperative bleeding. Due to the immaturity of their hemostatic system, the standard coagulation tests alone are inappropriate to guide hemostatic therapy in neonates. The use of indirect heparin concentration assays and global viscoelastic assays in the operating room is likely to represent the optimal strategy, and requires validation in neonates. Monitoring of global and regional indexes of oxygen availability and consumption on bypass have become possible; however, their use in neonates still has outstanding technical issues which should be addressed and hence needs further validation. Due to the immaturity of the neonatal myocardium, single‐shot cold cardioplegia solutions are thought to confer the best myocardial protection; their superiority when compared to more conventional modalities, however, remains to be demonstrated.

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Continuous Cerebral Perfusion for Aortic Arch Repair: Hypothermia Versus Normothermia

Cited by 31 publications

References 21 publications

Systematic Review and Meta‐Analysis of benefits and risks between normothermia and hypothermia during cardiopulmonary bypass in pediatric cardiac surgery

Systematic Review and Meta‐Analysis of benefits and risks between normothermia and hypothermia during cardiopulmonary bypass in pediatric cardiac surgery

Perioperative blood product transfusion of two different perfusion strategies on pediatric patients undergoing aortic arch surgery

Recent achievements and future developments in neonatal cardiopulmonary bypass

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