Deep hypothermic systemic circulatory arrest and continuous retrograde cerebral perfusion for surgery of aortic arch aneurysm

Ueda, Yuichi; Miki, Shigehito; Kusuhara, K; Okita, Yutaka; Tahata, T; Yamanaka, Kazuhiro

doi:10.1016/1010-7940(92)90096-g

Cited by 109 publications

(38 citation statements)

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“…With the reduction of body temperature both cellular metabolic activity and oxygen consumption by cells decreases. Since brain tissue is the least resistant to anoxia, new methods have been found to complement DHCA [9]. Retrograde cerebral perfusion and selective antegrade cerebral perfusion (SACP) provide blood flow through CNS during circulatory arrest [5].…”

Section: Introductionmentioning

confidence: 99%

Single-centre experience in surgery of acute aortic type A dissection and true aortic arch aneurysm

et al. 2016

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A b s t r a c tBackground: Surgery of the aortic arch is challenging. Aim:To assess the results of aortic arch surgery. Methods:Analysis of 172 patients operated on arch dissection (emergency group: 97 patients) or aneurysm (elective group: 75 patients) between 2007 and 2014. Arch surgery was defined as a procedure requiring circumferential anastomosis at the level of the aortic arch or the descending aorta with the use of techniques of brain protection (deep hypothermic circulatory arrest [DHCA] or selective antegrade cerebral perfusion [SACP]) and/or debranching of at least one supra-aortic vessel.Results: Men predominated in both groups (> 70%). Men were younger in the emergency group (55 vs. 66 years; p < 0.008). The operative risk was higher in the emergency group (19.2% vs. 12.5%; p < 0.001). Forty-nine per cent of the patients from the emergency group and 5% from the elective group were operated with antiplatelet therapy (p < 0.001). Extended hemiarch procedure was performed in 79% (n = 77) in the emergency and 76% (n = 57) in the elective group. Total arch replacement was performed in 19 (21%) patients from the emergency and 18 (24%) patients from the elective group. In these patients debranching was performed in 68% of the emergency patients group and in 67% of the elective group. Elephant trunk procedure (classic/frozen) was performed in 53% (n = 10) from the emergency and in 78% (n = 14) of patients from the elective group. Aortic valve sparing surgery was performed in 20% of patients from the emergency and 9% from the elective group (p = 0.063). DHCA was performed in 58% (n = 43) of patients from the elective group and 39% (n = 37) from the emergency group. SACP was performed in 61% (n = 58) of patients from the emergency and 42% (n = 31) from the elective group. Thirty-day mortality in the emergency group reached 33% (n = 32), and in the elective group 15% (n = 11; p = 0.007). In multivariate analysis, predictors of death in the emergency group were: Logistic EuroSCORE above 19.5%, extracorporeal circulation time above 228 min, and postoperative acute renal failure (ARF); and in the elective group: DHCA time above 26 min, rethoracotomy due to bleeding, and ARF. Follow-up was completed in 100% of patients in terms of vital status. The mean follow-up time of the patients from the emergency group was 24.3 ± 27.10 (min 0, max 92) months, and from the elective group 30.3 ± 24.5 (min 0, max 99) months. During the follow-up period all-cause mortality in the emergency group was 43% (n = 42/97), and in the elective group it was 36% (n = 27/75). Conclusions:Early mortality in the emergency group was higher, while long-term mortality did not differ among the groups. Postoperative ARF is a critical predictor of mortality in both groups.

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Section: Introductionmentioning

confidence: 99%

Single-centre experience in surgery of acute aortic type A dissection and true aortic arch aneurysm

et al. 2016

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“…Several studies have shown, that with this approach the safe duration of arrest is limited [8][9][10][11]. Therefore the search for refined method of protecting the brain resulted in groups favoring the use of retrograde cerebral perfusion [12,15,16] reporting very good results. The advantage of RCP being more thorough cooling of the brain and washing out air and debris material from the intracranial vessels.…”

Section: Discussionmentioning

confidence: 99%

Technical advances improved outcome in patients undergoing surgery of the ascending aorta and/or aortic arch: ten years experience

Krähenbühl¹,

Immer²,

Stalder³

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…RCP also maintains the brain temperature at an optimally low level due to the cold blood perfusate during circulatory arrest. 5 Furthermore, cannulation and/or clamp injury to fragile vessel tissues is avoided, and cerebral embolization from air, atheromatous plaque, thrombi, or debris is prevented. Recent reports have stated that the RCP technique has superior advantages over the antegrade cerebral perfusion technique; 6,7 however, transient or permanent neurological complications have been observed in some patients after surgery using RCP.…”

Section: Discussionmentioning

confidence: 99%

Postoperative brain complications following retrograde cerebral perfusion

et al. 1999

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This study was undertaken to investigate the neurological risk factors associated with the retrograde cerebral perfusion (RCP) technique, by examining the relationship between intraoperative parameters and post-operative brain complications. A total of 12 patients who underwent surgery for thoracic aortic aneurysms using the RCP technique were included in this study. Profound hypothermia was induced through cardiopulmonary bypass which was established with a femoral arterial cannula and bicaval return. During RCP, a venous drainage cannula from the superior vena cava (SVC) was switched over to the arterial return circuit, and oxygenated blood was retrogradely infused through the SVC. The perfusion flow rate was maintained at 273 +/- 113 ml/min and the SVC pressure was maintained at 15 +/- 6 mmHg. The RCP time was 68 +/- 27 min with a range of 27-130 min, and the lowest rectal temperature was 16 +/- 1 degrees C. The total elapsed time until emergence from anesthesia after the operation was 12 +/- 6 h. The operation time correlated with the awakening time (r = 0.729, P = 0.0088). Longer RCP times of up to 101 and 130 min tended to result in post-operative brain damage. The lowest rectal temperature also correlated with the awakening time (r = 0.697, P = 0.0149), and an inverse correlation between the SVC pressure and the awakening time was observed (r = -0. 727, P = 0.0091). These findings demonstrate the importance of reducing both the RCP and operation times to decrease the incidence of brain damage. If carried out under optimal conditions, including perfusion pressure and brain temperature, RCP could be marginally prolonged safely without causing major neurological complications.

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Deep hypothermic systemic circulatory arrest and continuous retrograde cerebral perfusion for surgery of aortic arch aneurysm

Cited by 109 publications

References 0 publications

Single-centre experience in surgery of acute aortic type A dissection and true aortic arch aneurysm

Single-centre experience in surgery of acute aortic type A dissection and true aortic arch aneurysm

Technical advances improved outcome in patients undergoing surgery of the ascending aorta and/or aortic arch: ten years experience

Postoperative brain complications following retrograde cerebral perfusion

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