Neuromonitoring and neuroprotection advances for aortic arch surgery

M, Falasa; Arnaoutakis, George J.; Janelle, Greg M.; Beaver, Thomas M.

doi:10.1016/j.xjtc.2020.12.045

Cited by 18 publications

(22 citation statements)

References 45 publications

(81 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In another arena of aortic surgery, approaches to pathology involving the arch remain fraught with concerns for neurological complications. In an invited expert review, Falasa and colleagues 12 review the historical and current practices in both neuroprotection as well as neuromonitoring during surgery on the aortic arch. Given the heterogeneity in pathology and anatomy, and hampered by the sparse clinical evidence available, it is not surprising that numerous techniques in both monitoring and approach have been proposed and advocated.…”

mentioning

confidence: 99%

“…In a similar approach to thoracoabdominal aortic aneurysm, Kemp and colleagues 13 discuss the pathogenesis of acute and delayed spinal cord ischemia associated with surgery on the thoracoabdominal aorta. Like the review by Falasa and colleagues, 12 the authors summarize the various etiologies and risk factors for paralysis and paraparesis. Kemp and colleagues 13 provide a nice review of adjuncts to reduce the risk of spinal cord injury.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Feature Editor summary: Highlighting Invited Expert Opinions on aortic subjects

Girardi

DeAnda

Ikonomidis

2021

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

This past year, 4 groups of authors accepted our invitation to submit expert opinions regarding surgical decision making for thoracic aortic disease. A few highlights of these article are outlined here, Gambardella and colleagues 1 published an interesting article making the assertion that, given the high acuity and technical challenges associated with type A aortic dissection repair, there is a valid argument that treatment for this disease should be regionalized to high-volume centers (performing >13 cases per year) and performed by high-volume surgeons (performing >5 cases per year). The article nicely summarizes the current literature regarding regionalization of surgery for acute type A aortic dissection and provides cogent insights.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Feature Editor summary: Highlighting Invited Expert Opinions on aortic subjects

Girardi

DeAnda

Ikonomidis

2021

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

“…Although the outcomes of arch surgery have improved, controversy about the strategy remains, as thoroughly reviewed by Falasa and colleagues. 1 The main controversies are regarding RCP vs ACP and uni-ACP vs bi-ACP.…”

mentioning

confidence: 99%

“…In most cases, RCP can be achieved through a separate cannula though the superior vena cava. 1 Because of the valve in the internal jugular vein, almost 99% of blood flow from RCP does not reach the brain. This is why DHCA alone can achieve similar results as HCA plus RCP, and RCP requires patient cooling to 18°C (ie, DHCA).…”

mentioning

confidence: 99%

“…This is why DHCA alone can achieve similar results as HCA plus RCP, and RCP requires patient cooling to 18°C (ie, DHCA). 1 The cooler the patient, the longer the time required for cooling and rewarming, and the greater the risk of more inflammation, coagulopathy, bleeding, and blood transfusion, especially in patients with ATAAD. This is one reason why surgeons are migrating from deep hypothermic to moderate hypothermic circulatory arrest plus ACP for ATAAD repair based on the International registry of aortic dissection 2 and German Registry of acute aortic dissection type A data.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Commentary: Individualize the strategy of cerebral protection in aortic arch surgery

Yang

2021

JTCVS Techniques

View full text Add to dashboard Cite

Proton magnetic resonance spectroscopy assessment of neonatal brain metabolism during cardiopulmonary bypass surgery

Spielman

Hurd

et al. 2022

NMR in Biomedicine

View full text Add to dashboard Cite

Here, we report on the development and performance of a robust 3‐T single‐voxel proton magnetic resonance spectroscopy (1H MRS) experimental protocol and data analysis pipeline for quantifying brain metabolism during cardiopulmonary bypass (CPB) surgery in a neonatal porcine model, with the overall goal of elucidating primary mechanisms of brain injury associated with these procedures. The specific aims were to assess which metabolic processes can be reliably interrogated by 1H MRS on a 3‐T clinical scanner and to provide an initial assessment of brain metabolism during deep hypothermia cardiac arrest (DHCA) surgery and recovery. Fourteen neonatal pigs underwent CPB surgery while placed in a 3‐T MRI scanner for 18, 28, and 37°C DHCA studies under hyperglycemic, euglycemic, and hypoglycemic conditions. Total imaging times, including baseline measurements, circulatory arrest (CA), and recovery averaged 3 h/animal, during which 30–40 single‐voxel 1H MRS spectra (sLASER pulse sequence, TR/TE = 2000/30 ms, 64 or 128 averages) were acquired from a 2.2‐cc right midbrain voxel. 1H MRS at 3 T was able to reliably quantify (1) anaerobic metabolism via depletion of brain glucose and the associated build‐up of lactate during CA, (2) phosphocreatine (PCr) to creatine (Cr) conversion during CA and subsequent recovery upon reperfusion, (3) a robust increase in the glutamine‐to‐glutamate (Gln/Glu) ratio during the post‐CA recovery period, and (4) a broadening of the water peak during CA. In vivo 1H MRS at 3 T can reliably quantify subtle metabolic brain changes previously deemed challenging to interrogate, including brain glucose concentrations even under hypoglycemic conditions, ATP usage via the conversion of PCr to Cr, and differential changes in Glu and Gln. Observed metabolic changes during CPB surgery of a neonatal porcine model provide new insights into possible mechanisms for prevention of neuronal injury.

show abstract

Neuromonitoring and neuroprotection advances for aortic arch surgery

Cited by 18 publications

References 45 publications

Feature Editor summary: Highlighting Invited Expert Opinions on aortic subjects

Feature Editor summary: Highlighting Invited Expert Opinions on aortic subjects

Commentary: Individualize the strategy of cerebral protection in aortic arch surgery

Proton magnetic resonance spectroscopy assessment of neonatal brain metabolism during cardiopulmonary bypass surgery

Contact Info

Product

Resources

About