Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion during ascending aorta-hemiarch replacement: A retrospective comparative study

Abstract

The use of antegrade selective cerebral perfusion and deep hypothermic circulatory arrest during ascending aorta-hemiarch replacement resulted in acceptable hospital mortality and neurologic outcome. Reduced postoperative intubation time and better renal function preservation were observed in the antegrade selective cerebral perfusion group.

Root Reconstruction with Total Replacement of Ascending Aorta Using Hypothermic Circulatory Arrest and Selective Cerebral Perfusion for Moderately Dilated Distal Ascending Aorta

“…The advantages of ASCP are that circulatory arrest can be safely extended up to 90 minutes, which allows more complex aortic repair [11]. However, hypothermia-associated coagulopathy and pulmonary, renal and micro embolic complications have been cited in the literature as important disadvantages [11]. Rectal temperature in our series was maintained at 25˚C during HCA and we did not find an increased risk of coagulative complications.…”

“…Technical simplicity and avoidance of aorta and arch vessel manipulation, as well as a bloodless operative field, render DHCA an alternative method of brain protection, especially during ascending aorta hemi-arch replacement, when a short period of circulatory arrest is anticipated. The advantages of ASCP are that circulatory arrest can be safely extended up to 90 minutes, which allows more complex aortic repair [11]. However, hypothermia-associated coagulopathy and pulmonary, renal and micro embolic complications have been cited in the literature as important disadvantages [11].…”

Selective Cerebral Perfusion with the Open Proximal Technique during Descending Thoracic or Thoracoabdominal Aortic Repair: An Option of Choice to Reduce Neurologic Complications

“…Hagl et al 11) noted that adjunctive SCP increased the permissible duration of CA from 40 min to 80 min for aortic arch surgery via a median sternotomy. Similarly, Eusanio et al 12) found that a CA duration of greater than 25 min was associated with an increased risk of TND in ascending aortic repair for acute type A dissection, whereas the duration of SCP had no effect on the neurologic outcome. Kawaharada et al reported the incidence rate of cerebral embolism as 3.4% in DTA or TAA repair under deep hypothermic CA for a mean duration of 28 min, and advocated the use of right axillary arterial perfusion.…”

Goal-directed-perfusion in neonatal aortic arch surgery

“…Several studies suggested that longer duration of deep hypothermic circulatory arrest is associated with neurocognitive impairment (12)(13)(14), but despite the missing evidence of a clear time limit (12,15), perioperative seizures with impaired motor development (16) and brain damage evident on MRI were consistent with RCP as well (10,17,18). Nevertheless, improved outcome reports (early and late) about shorter postoperative ventilation, improved renal function and adequate time-related neurodevelopment have been subsequently published after using RCP (15,19,20).…”