Hypothermic cardiopulmonary bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta

Kouchoukos, Nicholas T.; Masetti, Paolo; Rokkas, Chris K.; Murphy, Suzan F.

doi:10.1016/s0003-4975(02)04153-x

Cited by 126 publications

(97 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Two Extent III patients underwent repair utilising partial cardiopulmonary bypass and aortic clamping. The mean CPB and HCA were 246 min (95% CL 217-278) and 21 min (95% CL [16][17][18][19][20][21][22][23][24], respectively. The mean intercostals, hypogastric, visceral and renal ischaemic times (15 8C) were 40 min (95% CL 34-46), 51 min (95% CL 34-69), 92 min (95% CL 38-167) and 86 min (95% CL 32-139), respectively.…”

Section: Operative Details and Outcomesmentioning

confidence: 98%

Presentation and outcome of Marfan's syndrome patients with dissection and thoraco-abdominal aortic aneurysm

Kalkat

Rahman

Kotidis

et al. 2007

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

Background: In Marfan's syndrome, there is a paucity of data regarding intervention criteria for surgery of the dissected thoraco-abdominal aorta. Methods: A retrospective analysis of 22 Marfan's patients with distal aortic dissection managed between September 1999 and April 2006 was performed. Serial diameters and linear expansion rates were calculated from imaging studies and the outcome of intervention was analysed.Results: There were 14/22 male patients (median age 38 years), and 18 had prior aortic surgery. Surgery was recommended in 20 patients and undertaken in 19 (1 died prior to operation). Of the operated patients, 2 presented with rupture, 2 with airway obstruction, 1 with intermittent paraplegia and 14 underwent planned surgery for increased expansion rate or pain. All patients had residual type A or chronic type B dissection. The median aortic dimension at surgery was 6.7 cm (interquartile range (IQR) 5.5-8.2). The preoperative mean expansion rate increased from 0.5 cm/year to 1.7 cm/year ( p < 0.001), prior to operation. Fifteen patients underwent Crawford Extent II, two underwent Extent I and two underwent Extent III repair. Profound hypothermia and CSF drainage was used in 16 and 18 patients, respectively. There was no early mortality, paraplegia or renal failure. At a median postoperative follow-up of 56 months (range 6-86), the survival of the operated cohort was 90%. Conclusions: Thoraco-abdominal aortic aneurysm repair in Marfan's syndrome can be performed with good outcomes. Intervention should be based on size or accelerated expansion. Any role of endovascular management needs careful consideration. #

show abstract

Section: Operative Details and Outcomesmentioning

confidence: 98%

Presentation and outcome of Marfan's syndrome patients with dissection and thoraco-abdominal aortic aneurysm

Kalkat

Rahman

Kotidis

et al. 2007

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…Hypothermic cardiopulmonary bypass with circulatory arrest has also been reported to be an important adjunct for operations on the distal aortic arch, descending thoracic aorta, and thoracoabdominal aorta for preventing spinal cord injures and renal and visceral organ system failure. 25 In type B IRAD surgical patients, cerebral perfusion showed a trend for improved outcome (PϽ0.17), even when used sparingly (17.1%). Utilization of antegrade cerebral perfusion from a left thoracotomy has not been widely adopted by the surgical community, but it seems safe and feasible in more complicated interventions.…”

Section: Trimarchi Et Al Surgery In Acute Type B Aortic Dissection I-361mentioning

confidence: 99%

Role and Results of Surgery in Acute Type B Aortic Dissection

et al. 2006

View full text Add to dashboard Cite

are often reported for those in small series or for those cared for at a single institution over a long time period, during which a continuous evolution in techniques has occurred. Accordingly, we sought to evaluate the clinical features and surgical results of patients enrolled in the International Registry of Acute Aortic Dissection by identifying primary factors that influenced surgical outcome and estimating average surgical mortality for ABAD in the current era. Methods and Results-A comprehensive analysis of 290 clinical variables and their relation to surgical outcomes for 82 patients who required surgery for ABAD (from a population of 1256 patients; meanϮSD age, 60.6Ϯ15.0 years; 82.9% male) and who were enrolled in the International Registry of Acute Aortic Dissection was performed. The overall in-hospital mortality was 29.3%. Factors associated with increased surgical mortality based on univariate analysis were preoperative coma or altered consciousness, partial thrombosis of the false lumen, evidence of periaortic hematoma on diagnostic imaging, descending aortic diameter Ͼ6 cm, right ventricle dysfunction at surgery, and shorter time from the onset of symptoms to surgery. Factors associated with favorable outcomes included radiating pain, normotension at surgery (systolic blood pressure 100 to 149 mm Hg), and reduced hypothermic circulatory arrest time. The 2 independent predictors of surgical mortality were age Ͼ70 years (odds ratio, 4.32; 95% confidence interval, 1.30 to 14.34) and preoperative shock/hypotension (odds ratio, 6.05; 95% confidence interval, 1.12 to 32.49). Conclusions-The

show abstract

“…Changes observed in these potentials that can suggest spinal cord ischemia allow an immediate intervention on the part of the surgeon in an attempt to correct the factors responsible for their occurrence 2,4-6. In parallel, several maneuvers have been proposed in an effort to minimize the risk of spinal ischemia during the correction of thoracic and abdominal aorta aneurysms, although with controversial results. These maneuvers include pharmacological interventions 7,8,9 , decrease of aortic crossclamping time 10 , reduction of the distance between the vascular clamps 10 , systemic 11 or regional 12 hypothermia, systemic hyperthermia 13,14 , reimplantation of the intercostal and lumbar arteries 9,15 , CSF drainage 9,15,16 , and perfusion of the distal aorta at the last cross-clamping 1,9 .…”

Section: Introductionmentioning

confidence: 99%

Pré-condicionamento isquêmico e monitorização da função medular na abordagem da aorta torácica descendente

Mônaco¹,

Benício²,

Contreras³

et al. 2007

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

SummaryObjectives: To evaluate the effectiveness of acute ischemic preconditioning (IP), based on somatosensory evoked potentials (SSEP) monitoring, as a method of spinal cord protection and to asses SSEP importance in spinal cord neuromonitoring.Methods: Twenty-eight dogs were submitted to spinal cord ischemic injury attained by descending thoracic aorta cross-clamping. In the C45 group, the aortic cross-clamping time was 45 min (n=7); in the IP45 group, the dogs were submitted to IP before the aortic cross-clamping for 45 min (n=7). In the C60 group, the dogs were submitted to 60 min of aortic cross-clamping (n=7), as in the IP60 group that was previously submitted to IP. The IP cycles were determined based on SSEP changes.Results: Tarlov scores of the IP groups were significantly better than those of the controls (p = 0.005). Paraplegia was observed in 3 dogs from C45 and in 6 from C60 group, although all dogs from IP45 group were neurologically normal, as 4 dogs from IP60. There was a significant correlation between SSEP recovery time until one hour of aortic reperfusion and the neurological status (p = 0.011), showing sensitivity of 75% and specificity of 83%.Conclusion: Repetitive acute IP based on SSEP is a protection factor during spinal cord ischemia, decreasing paraplegia incidence. SSEP monitoring seems to be a good neurological injury assessment method during surgical procedures that involve spinal cord ischemia.

show abstract

Hypothermic cardiopulmonary bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta

Cited by 126 publications

References 3 publications

Presentation and outcome of Marfan's syndrome patients with dissection and thoraco-abdominal aortic aneurysm

Presentation and outcome of Marfan's syndrome patients with dissection and thoraco-abdominal aortic aneurysm

Role and Results of Surgery in Acute Type B Aortic Dissection

Pré-condicionamento isquêmico e monitorização da função medular na abordagem da aorta torácica descendente

Contact Info

Product

Resources

About