Long-Term Survival and Quality of Life After Hypothermic Circulatory Arrest in Aortic Surgery

Stewart, Juhani A.; Ilkka, V. H.; Jokinen, Jukka; Vakkuri, Anne; Suojaranta, Raili; Wennervirta, Johanna; Salminen, Ulla‐Stina

doi:10.1177/1457496918766719

Cited by 5 publications

(2 citation statements)

References 14 publications

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“…These results justify operative treatment in this high-risk patient population. This study supported the idea of using the hypothermic circulatory arrest as a method of cerebral protection in general [10].…”

Section: Discussionsupporting

confidence: 80%

Effect of moderate hypothermic circulatory arrest on neurological outcomes in elderly patients undergoing replacement of the thoracic aorta

et al. 2020

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Background: Various studies evaluated the relationship between hypothermic circulatory arrest and neurological outcome in patients undergoing replacement of ascending aorta. The current analysis focuses on the effect of moderate hypothermic circulatory arrest (MHCA) on elderly patients. The aim of our study was to evaluate the impact of MHCA on neurological outcomes in elderly patients undergoing replacement of the ascending aorta. Results: We retrospectively analyzed 905 consecutive patients, who underwent elective replacement of ascending aorta in MHCA (24 ± 2°C, nasopharyngeal) between 2001 and 2015. Patients with acute aortic dissection were excluded from this study. Patients were divided into two groups: those aged 75 years and older (elderly group 22.4%, n = 203) and those younger than 75 years (younger group 77.6%, n = 702). The average age was 63.2 ± 10.2 in the young group vs. 78.7 ± 3.0 years in elderly group (p < 0.001). The elderly group had a significantly higher EuroSCORE II [26.7% (18.1, 36.3) vs. 11.6% (7.4, 19.9); p < 0.001)]. The incidence of coronary heart disease (49.8% vs. 35.6%, p < 0.001) and chronic renal failure (17.2% vs. 9.1%, p = 0.001) was significantly higher in the elderly group. Intraoperatively, the time of MHCA [14 min (12, 17) vs. 15 min (12, 18); p = 0.42], cardiopulmonary bypass [139 min (110, 183) vs. 144 min (113, 189); p = 0.225], and cross-clamping [91 min (63, 116) vs. 92 min (65, 127); p = 0.348] was similar in both groups. Postoperatively, a higher incidence of delirium was significantly reported in the elderly group (24.1% vs. 9.0%, p < 0.001). However, there was no significant difference regarding neurological complications between both groups. A 30-day mortality was acceptable for the elderly group, but significantly higher compared with the younger group (7.1% vs. 3.5%, p = 0.031). Conclusions: Our study suggests that surgical replacement of the ascending aorta in MHCA can also be applied safely in elderly patients without increasing the risk of severe neurological complications.

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Section: Discussionsupporting

confidence: 80%

Effect of moderate hypothermic circulatory arrest on neurological outcomes in elderly patients undergoing replacement of the thoracic aorta

et al. 2020

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“…ECS in those situations only indicates brain functional arrest. Similarly, brain functional arrest can be reversible when associated with these situations 6,8 . In our study, ancillary tests were always obtained in the appropriate clinical context.…”

Section: Discussionmentioning

confidence: 96%

Use of duplex echoencephalography to evaluate brain death in children: A novel approach to the diagnosis

Sharma

Sheikh

Maertens

2022

Journal of Neuroimaging

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Background andPurpose: Brain death is defined as the irreversible cessation of brain function with a known etiology. This study aims to establish the value of duplex echoencephalography (DEG) in children fulfilling clinical brain death diagnostic criteria. Methods: DEG must show intracranial brain structures. Power Doppler is used to assess venous flow when feasible. Color Doppler patterns in all major arteries are assessed. Spectral analysis of arterial flow is divided into four grades: grade 1: inverted flow during entire diastole with time average peak velocity (TAPV) less or equal to zero; grade 2: disappearance of the inverted diastolic flow at the end of diastole; grade 3: oscillating pattern in early diastole; and grade 4: no diastolic flow with systolic blip. To fulfill diagnosis of brain death, brain perfusion must be lost for 30 minutes.Results: DEG is performed in 41 pediatric patients. In infants, loss of venous flow occurs regardless of the etiology. Grade 1 is the most common arterial color flow pattern and TAPV is always below zero. A pulsatile color flow is associated with three other types of flow patterns (grades 2-4). TAPV is not calculated, when there is loss of diastolic flow.Diagnosis of brain death is validated using nuclear brain scan in 4 patients. Two have a grade 1 flow pattern, while the other two have a grade 4 flow pattern. Conclusions:In children, DEG following a strict protocol can be used to confirm diagnosis of brain death in the appropriate clinical setting.

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Thoracic Aortic Surgery

Tan

Jarral

Salmasi

et al. 2022

Patient Reported Outcomes and Quality of Life in Cardiovascular Interventions

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Long-Term Survival and Quality of Life After Hypothermic Circulatory Arrest in Aortic Surgery

Cited by 5 publications

References 14 publications

Effect of moderate hypothermic circulatory arrest on neurological outcomes in elderly patients undergoing replacement of the thoracic aorta

Effect of moderate hypothermic circulatory arrest on neurological outcomes in elderly patients undergoing replacement of the thoracic aorta

Use of duplex echoencephalography to evaluate brain death in children: A novel approach to the diagnosis

Thoracic Aortic Surgery

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