Mortality And Cerebral Outcome In Patients Who Underwent Aortic Arch Operations Using Deep Hypothermic Circulatory Arrest With Retrograde Cerebral Perfusion: No Relation Of Early Death, Stroke, And Delirium To The Duration Of Circulatory Arrest

Okita, Yutaka; Takamoto, Shinichi; Ando, Motomi; Morota, Tetsuro; Matsukawa, Ritsu; Kawashima, Yasunaru

doi:10.1016/s0022-5223(98)70451-9

Cited by 183 publications

(104 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Esses achados, assim como outros relatos 30,31,39,40 , parecem substanciar uma abordagem cautelosa sobre o arco, com preferência à técnica do hemiarch repair com anastomose aberta, e uso adjuvante de adesivo biológico, à exceção de casos com grande destruição intra-arco ou descontinuidade com a porção descendente da aorta torácica; nesta situação, a melhor alternativa passa a ser a inserção um enxerto tubular de dacron na aorta descendente, cuja extremidade distal é desprovida de anastomose ("tromba de elefante"), e reimplante dos ramos supra-aórticos 41,42 . Na eventualidade futura de indicação de correção da aorta descendente, a extremidade livre do enxerto pode ser anastomosada diretamente à parede aórtica, ou estendida por meio de um tubo adicional a segmentos mais distais, através de toracotomia esquerda.…”

Section: Dissecções Agudas Da Aortaunclassified

Diretrizes para a cirurgia das doenças da aorta

Albuquerque¹,

Palma²,

Braile³

et al. 2004

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

Section: Dissecções Agudas Da Aortaunclassified

Diretrizes para a cirurgia das doenças da aorta

Albuquerque¹,

Palma²,

Braile³

et al. 2004

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

“…RCP allows a deep and homogeneous cooling of the brain as well as washing solid particles, air bubbles and metabolites, thereby decreasing acidosis in the ischemic brain (36). Associated with DH has allowed to reduce mortality, stroke (40,41) and delirium significantly with respect to the use of isolated DH (42)(43)(44).…”

Section: Rcpmentioning

confidence: 99%

Intraoperative care for aortic surgery using circulatory arrest

et al. 2017

View full text Add to dashboard Cite

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).

show abstract

“…Although this is lower than the 25% incidence of TND associated with arch reconstruction using DHCA alone (17), it is still a significant incidence of inadequate cerebral protection. Other groups have also reported a significant incidence of TND with the use of DHCA+RCP (30,31,32). The high incidence of TND and the recent popularity of antegrade cerebral perfusion has led to decreased utilization of RCP by most aortic surgeons (21).…”

Section: Retrograde Cerebral Perfusionmentioning

confidence: 99%