Does retrograde cerebral perfusion affect risk factors for stroke and mortality after hypothermic circulatory arrest?

Wong, Carl; Bonser, Robert S.

doi:10.1016/s0003-4975(99)00434-8

Cited by 29 publications

(14 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Clinical outcome studies comparing RCP versus HCA have also yielded mixed results. RCP has been found to be associated with neurological morbidity rates that are either similar to those associated with HCA [15,16] or lower [17,18], especially in older patients [19]. In studies which included selective (anterograde) cerebral perfusion patients, RCP patients had similar outcome in two studies [20,21], and worse outcome in one [22].…”

Section: Clinical Outcome In Thoracic Aortic Surgerymentioning

confidence: 99%

Retrograde cerebral perfusion during thoracic aortic surgery and late neuropsychological dysfunction

Reich

Uysal

Ergin

et al. 2001

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

Objective: Retrograde cerebral perfusion (RCP) is commonly used in thoracic aortic surgery, ostensibly to provide metabolic support, maintain cerebral hypothermia and/or wash out particulate emboli. We tested the hypothesis that RCP would affect neuropsychological outcome in a clinical cohort. Methods: Ninety-four patients undergoing elective thoracic aortic repairs requiring deep hypothermic circulatory arrest consented to participate in this study. These patients underwent preoperative neuropsychological evaluation and comprise the reference group. Fifty-six of these patients also underwent neuropsychological evaluation several weeks postoperatively, 12 of whom (21%) had RCP. The neuropsychological domains tested were attention, processing speed, memory, executive function, and ®ne motor function. A global assessment of impairment, negative neuropsychological outcome (NNO), was de®ned as a postoperative decrease in function in two or more neuropsychological domains for patients with at least three domains tested both pre-and postoperatively (n 48). The relationship of three potential predictors (RCP, cerebral ischemia time and patient age) to negative outcomes was analyzed using Wilcoxon two-sample tests, x 2 tests, Mantel±Haenszel tests and multiple logistic regression. P , 0:05 was considered signi®cant. Results: Memory dysfunction and NNO had strong associations with RCP. This effect remained signi®cant when controlling separately for age and cerebral ischemia time. Conclusions: The effects of RCP are dif®cult to distinguish from those of age and prolonged cerebral ischemia time, because complex thoracic aortic repairs are associated with advanced age, prolonged cerebral ischemia and use of RCP. Despite this limitation, these preliminary data indicated that RCP had no bene®cial effect (and most likely a negative effect) upon cognitive outcome. q

show abstract

Section: Clinical Outcome In Thoracic Aortic Surgerymentioning

confidence: 99%

Retrograde cerebral perfusion during thoracic aortic surgery and late neuropsychological dysfunction

Reich

Uysal

Ergin

et al. 2001

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…The partial or total replacement of aortic arch is thus associated with high mortality, as well as incidence of neurological injury. Mortality is widely ranged between 2.8% and 24%, depending on the extent of replaced ascending aorta and arch, age, emergency, comorbidity, etc 1–5 . The incidence of postoperative neurological dysfunction is expressed as permanent neurological dysfunction (PND) or temporary neurological dysfunction (TND).…”

mentioning

confidence: 99%

Antegrade Versus Retrograde Cerebral Perfusion in Relation to Postoperative Complications Following Aortic Arch Surgery for Acute Aortic Dissection Type A

Apostolakis

Koletsis

Dedeilias

et al. 2008

Journal of Cardiac Surgery

View full text Add to dashboard Cite

show abstract

“…They found increased tissue blood flow at a higher perfusion pressure of 34-40 mmHg [10]. Reich et al and Wong et al found no clinical benefit of RCP although circulatory arrest times were longer in the RCP groups [11,12]. Baufreton and coworkers report a benefit of RCP in patients undergoing circulatory arrests of more than 45 minutes [13].…”

Section: Discussionmentioning

confidence: 97%

Extracorporeal circulation in adult thoracic aortic surgery

et al. 2004

View full text Add to dashboard Cite

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...

show abstract

Does retrograde cerebral perfusion affect risk factors for stroke and mortality after hypothermic circulatory arrest?

Cited by 29 publications

References 11 publications

Retrograde cerebral perfusion during thoracic aortic surgery and late neuropsychological dysfunction

Retrograde cerebral perfusion during thoracic aortic surgery and late neuropsychological dysfunction

Antegrade Versus Retrograde Cerebral Perfusion in Relation to Postoperative Complications Following Aortic Arch Surgery for Acute Aortic Dissection Type A

Extracorporeal circulation in adult thoracic aortic surgery

Contact Info

Product

Resources

About