Moderate hypothermic circulatory arrest in total arch repair for acute type A aortic dissection: clinical safety and efficacy

Gong, Ming; Ma, Wei-Guo; Guan, Xin‐Yuan; Wang, Long-Fei; Li, Jia-Chen; Lan, Feng; Sun, Li‐Zhong; Zhang, Hongjia

doi:10.21037/jtd.2016.02.75

Cited by 27 publications

(24 citation statements)

References 36 publications

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“…We compared studies performed only in patients with spinal cord coverage T8 or beyond or 15 cm or greater stent length (n ¼ 6, 201 patients), 15,23,[32][33][34]42 with studies performed only in patients with stent length equal to 10 cm (n ¼ 19, 1634 patients). 15,[17][18][19]21,22,24,25,27,28,33,35,37,[40][41][42]45,46 The patients Figure E1).…”

Section: Subgroup Analysismentioning

confidence: 99%

“…When we compared studies performed only in patients with acute type A aortic dissection (n ¼ 12, 1300 patients) 21,23,25,[27][28][29][30]35,37,41,46,47 with studies performed only in patients with nonacute type A dissection and aneurysm (n ¼ 14, 741 patients), 14,15,17,19,22,[24][25][26]34,40,[42][43][44][45] we found the following results: The pooled mortality rate was 9.2% (95% CI, 6.9-12.4) in the patients with acute type A and 7.6% (95% CI, 4.9-11.4) in the patients with nonacute dissection and aneurysm (P ¼ .46). The pooled rate of stroke in these 2 groups was 9.3% (95% CI, 4.5-18.5) and 6.6% (95% CI, 3.1-13.5) (P ¼ .51), and the pooled rate of SCI was 2.4% (95% CI, 1.3-4.2) and 5.2% (95% CI, 3.1-8.5) (P ¼ .05), respectively ( Figure E2).…”

Section: Acute Type a Versus Nonacute Type A And Aneurysmmentioning

confidence: 99%

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Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

Preventza

Liao

Olive

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

174

136

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Objective: The frozen elephant trunk technique's safety regarding spinal cord ischemia has been questioned. We used a meta-analysis to determine the rates of adverse neurologic events and mortality. Methods:We searched PubMed/Medline, Embase, Scopus, and Cochrane databases (inception to April 2018) to identify studies of neurologic events after the frozen elephant trunk procedure. Separate meta-analyses were conducted with random-effects models to assess frozen elephant trunk associations with spinal cord ischemia, stroke, operative mortality, and all adverse events combined. Subgroup analyses compared outcomes in patients with acute versus nonacute type A dissection and aneurysm and with different extents of coverage.Results: Thirty-five studies (total N ¼ 3154) met inclusion criteria. The pooled rates of the outcomes of interest were 4.7% (95% confidence interval, 3.5-6.2) for spinal cord ischemia, 7.6% (95% confidence interval, 5.0-11.5) for stroke, and 8.8% (95% confidence interval, 7.0-10.9) for operative mortality. The spinal cord ischemia event rate was higher with stent length 15 cm or greater or coverage to T8 or beyond than with stent length of 10 cm (11.6% vs 2.5%, P<.001). Adverse event rates in patients with acute type A aortic dissection versus nonacute dissection or aneurysm were as follows: mortality 9.2% versus 7.6% (P ¼ .46), stroke 9.3% versus 6.6% (P ¼ .51), and overall adverse events 22.0% versus 16.5% (P ¼ .41). Conclusions:As the frozen elephant trunk procedure becomes more popular, accurate data regarding outcomes are vital. We associated the frozen elephant trunk technique with (nonsignificantly) more adverse events overall in acute type A dissection cases. Stent length of 10 cm was associated with significantly less risk of spinal cord ischemia. Using a stent 15 cm or greater or coverage extending to T8 or farther should be avoided. (J Thorac Cardiovasc Surg 2020;160:20-33) 35 Studies 3154 Patients 4.7% SCI 7.6% Stroke 8.8% Mortality Extent of SC Coverage Dissection (Type A or DeBakey Type I) / Aneurysm, Nondissection Overall Adverse Event (Mortality / Stroke / SCI) ≥ 15 cm stent length / Coverage at or distal to T8 (6 studies / 201 patients)From the

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Section: Subgroup Analysismentioning

confidence: 99%

Section: Acute Type a Versus Nonacute Type A And Aneurysmmentioning

confidence: 99%

Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

Preventza

Liao

Olive

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

174

136

View full text Add to dashboard Cite

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“…In 2016, Gong et al supported our strategy. His study implies the clinical safety and efficacy of MHCA in emergency aortic arch repair, which can provide comparable cerebral and visceral organ protection while decreasing CPB and aortic crossclamp times without increasing the risk of operative mortality and morbidity [18].…”

Section: Discussionmentioning

confidence: 99%

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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“…In recent studies, no significant differences were found in the incidence of renal failure or biomarkers of visceral dysfunction between the two cooling techniques as long as the PCT does not exceed 60 minutes (32,33).…”

Section: Dh Vs Moderatementioning

confidence: 98%

Intraoperative care for aortic surgery using circulatory arrest

et al. 2017

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Abstract:The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20.1-28 ℃) associated with unilateral or bilateral selective cerebral perfusion methods. In this way the neurological results are better, the interval of security is greater and the times of extracorporeal circulation are smaller. Even so, it is necessary to take into account that there is the possibility of ischemia in the lower part of the body, especially of the abdominal viscera and the spinal cord, therefore the time of circulatory stop should be limited and not to exceed 80 minutes. Evidence of possible neurological drug protection is very weak and only mannitol, magnesium, and statins can produce some benefit. Inhalational anesthetics and some intravenous seem to have advantages, but more studies would be needed to test their long-term benefit. Other important parameters to be monitored during these procedures are blood glucose, anemia and coagulation disorders and acid-base balance. The recommended monitoring is common in complex cardiovascular procedures and it is of special importance the neurological monitoring that can be performed with several techniques, although currently the most used are Bispectral Index (BIS) and Near-Infrared Spectroscopy (NIRS). It is also essential to monitor the temperature routinely at the nasopharyngeal and bladder level and it is important to control coagulation with rotational thromboelastometry (ROTEM).

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Moderate hypothermic circulatory arrest in total arch repair for acute type A aortic dissection: clinical safety and efficacy

Cited by 27 publications

References 36 publications

Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients

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

Intraoperative care for aortic surgery using circulatory arrest

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