Direct visualization of minimal cerebral capillary flow during retrograde cerebral perfusion: an intravital fluorescence microscopy study in pigs

Duebener, Lennart F.; Hagino, Ikuo; Schmitt, Katharina; Sakamoto, Takahiko; Stamm, Christof; Zurakowski, David; Schäfers, Hans‐Joachim; Jonas, Richard A.

doi:10.1016/s0003-4975(02)04724-0

Cited by 27 publications

(18 citation statements)

References 18 publications

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“…ScO 2 was monitored with near infrared spectroscopy in all cases. A number of studies have shown that RCP may not provide enough oxygen to the brain during DHCA (27)(28)(29)(30), which is consistent with the current findings although the two groups had a similar incidence of postoperative delirium. In group 1, the decrease in ScO 2 during CPB was not related to the occurrence of postoperative delirium.…”

Section: Pi and Ri Of Ica And Ecasupporting

confidence: 89%

Increased cerebrovascular resistance after retrograde cerebral perfusion: A Doppler study

et al. 2012

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Section: Pi and Ri Of Ica And Ecasupporting

confidence: 89%

Increased cerebrovascular resistance after retrograde cerebral perfusion: A Doppler study

et al. 2012

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“…18,19 Basic features of our current technique for acute dissection or aneurysm of the distal ascending or transverse aortic arch included cardiopulmonary bypass, profound hypothermia, circulatory arrest, and RCP. Cerebral monitoring with near-infrared spectroscopy or power mode transcranial Doppler confirmed adequate cerebral circulation during perfusion.…”

Section: Techniquementioning

confidence: 99%

“…12,24 These concerns have been based on observations of inadequate cerebral perfusion as detected by specific cerebral monitoring modalities (transcranial Doppler) or direct perfusion studies. 19,25 Yet in many of these reports, the stroke incidence was still significant, ranging from 3% to 12%. This reiterates the point that postoperative stroke after ascending and transverse arch repairs remains multifactorial in etiology and that providing "adequate" cerebral perfusion, whether antegrade or retrograde, does not ensure prevention of neurological complications.…”

Section: Estrera Et Al Ascending and Transverse Aortic Arch Repair S163mentioning

confidence: 99%

Ascending and Transverse Aortic Arch Repair

et al. 2008

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“…Both studies [8,9]. On the contrary, Li and coworkers found no increase in cerebral edema after RCP in pigs.…”

Section: Discussionmentioning

confidence: 92%

“…Duebner and coworkers showed no significant cortical capillary flow in piglets undergoing DHCA and RCP [8].…”

Section: Discussionmentioning

confidence: 95%

Extracorporeal circulation in adult thoracic aortic surgery

et al. 2004

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Extrakorporale Zirkulation in der Chirurgie der thorakalen Aorta des Erwachsenen Zusammenfassung. Grundlagen: In der Chirurgie der thorakalen Aorta sind eine optimale Organprotektion und die Wahl der Kanülierungsstelle für den kardiopulmonalen Bypass von großer Bedeutung, insbesondere wenn ein tief hypothermer Kreislaufstillstand (DHCA) notwendig ist.Methodik: Standard für die extrakorporale Zirkulation bei Operationen an der thorakalen Aorta ist die Kanülie-rung der Aorta ascendens, Arteria femoralis oder Arteria axillaris. Neben der Kardioplegie wird zur speziellen Organprotektion die antegrade oder retrograde zerebrale Perfusion durchgeführt.Ergebnisse: Bei 277 Patienten mit Operationen an der thorakalen Aorta (50 % akute Fälle) war die Hospitalmortalität 13 %. Die Schlaganfallsrate bei Patienten mit DHCA war 8/135 (5,9 %). Eine signifikante Reduktion der Schlaganfallsrate durch retrograde zerebrale Perfusion (4 % mit RCP vs. 6.4 % ohne RCP) konnte nicht nachgewiesen werden. Bei 6 Patienten mit DHCA und antegrader zerebraler Perfusion wurden keine Schlaganfälle beobachtet. Die Kanülierung der A. axillaris erfolgte in den letzten Jahren in zunehmendem Maße, sie ist zurzeit die erste Wahl bei akuten Aortendissektionen Typ A. Die postoperative Aufenthaltsdauer auf der Intensivstation war 3 (1-72) Tage.Schlussfolgerungen: Mit Hilfe geeigneter Perfusionstechniken zur Hirn-, Rückenmarks-und Herzprotektion sind Operationen an der thorakalen Aorta mit akzeptablem Risiko möglich. Die axilläre Kanülierung gewährleis-tet eine sichere Perfusion aller gefährdeten Organe. Bei tief hypothermem Kreislaufstillstand ist damit auch eine antegrade zerebrale Perfusion möglich mit weiterer Reduktion des Risikos neurologischer Komplikationen.Schlüsselwörter: Kardiopulmonaler Bypass, Aortenaneurysma, zerebrale Perfusion, Arteria axillaris.Summary. Background: In thoracic aortic surgery optimum organ protection and the cannulation sites for extracorporeal circulation are a critical issue, especially if deep hypothermic circulatory arrest is necessary.Methods: Standard cannulation sites for surgery of the thoracic aorta are the ascending aorta, femoral artery, or axillary artery. Specific organ protection is performed as cardioplegia and antegrade or retrograde cerebral perfusion.Results: The hospital mortality of 277 patients (50 % acute cases) undergoing surgery of the thoracic aorta was 13 %. 8/135 (5.9 %) patients undergoing deep hypothermic circulatory arrest (DHCA) had a postoperative new stroke. From 25 patients undergoing retrograde cerebral perfusion 4 % had a new postoperative stroke, whereas of 110 patients undergoing DHCA without cerebral perfusion 6.4 % had a new postoperative stroke (p = n.s.). In 6 patients undergoing antegrade cerebral perfusion and DHCA no stroke was observed postoperatively. Axillary artery cannulation was increasingly used for cardiopulmonary bypass, especially in acute aortic dissection type A. The postoperative length of ICU stay was 3 (1-72) days in the whole series.Conclusions: With adequate perf...

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Direct visualization of minimal cerebral capillary flow during retrograde cerebral perfusion: an intravital fluorescence microscopy study in pigs

Cited by 27 publications

References 18 publications

Increased cerebrovascular resistance after retrograde cerebral perfusion: A Doppler study

Increased cerebrovascular resistance after retrograde cerebral perfusion: A Doppler study

Ascending and Transverse Aortic Arch Repair

Extracorporeal circulation in adult thoracic aortic surgery

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