Prospective comparative study of brain protection in total aortic arch replacement: deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion

Cerbral Protection Strategies for

“…However, by using a multivariate analysis, the use of DHCA+ACP significantly reduced the incidence of TND compared to DHCA+RCP or DHCA alone (31). In a randomized controlled trials comparing ACP vs RCP for total arch replacements performed under DHCA, Okita and colleagues showed no difference in stroke between patients undergoing ACP vs RCP, however ACP significantly reduced the incidence of TND (ACP 13.3% vs. RCP 33.3%, p=0.05) (46). These results were also replicated in series of 48 patients undergoing arch reconstruction during type A aortic dissection repair.…”

Comparison between antegrade and retrograde cerebral perfusion or profound hypothermia as brain protection strategies during repair of type A aortic dissection

“…RCP patients demonstrated a trend towards a higher rate of postoperative stroke that may be attributed to the fact that more patients in the RCP group had a history of cerebrovascular accident. Other studies have also demonstrated no difference between RCP and ACP for postoperative stroke; however, RCP tended to have more cases of transient neurological damage (4,6,12,14). The most important risk factors for stroke are circulatory arrest time over 40 minutes and prolonged CPB time (15).…”

“…Damage to the brain is the most prevalent complication following aortic surgery (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Attempts to mitigate this risk have evolved over time from the use of deep hypothermic circulatory arrest (DHCA) alone, to DHCA with retrograde cerebral perfusion (RCP), and finally to moderate hypothermic circulatory arrest (MHCA) with unilateral or bilateral antegrade cerebral perfusion (ACP) (1,13).…”

Combined Surgical and Endovascular Approach for the Treatment of Complex Thoracic Aortic Pathologies

“…The arterial cannula is introduced via a short 8-mm Dacron prosthesis, which is anastomosed to the right axillary artery. This permits the surgeon to subsequently perform a safe sternotomy on the one hand, and a means of achieving antegrade cerebral perfusion during circulatory arrest on the other (Strauch et al 2005, Shimazaki et al 2004, Numata et al 2003, Okita et al 2001. (Figure 2) After median sternotomy, a venous two-step cannula is placed in the right atrium and the patient is cooled to 25°C at the heart-lung machine in order to achieve moderate hypothermia (Minatoya et al 2008, Pacini et al 2007).…”